Exploring other options for palliative care

Paula Span…wrote last week about the poor choices facing patients, most very old and within six months of death, who need nursing home care after a hospitalization.

Medicare will pay for hospice, the acknowledged gold standard for those at the end of life and their families, and it will also pay for skilled nursing (known in this universe as the “sniff” benefit, for Skilled Nursing Facility or S.N.F.)…but only rarely will it cover both at the same time, which creates a financial bind.

Rather than pay hundreds of dollars a day out of pocket for room and board in a nursing home, most families opt for S.N.F. coverage. But they pay a price in other ways: they lose the visits by nurses and aides and social workers, the comfort care, the pain relief and the spiritual support that can make hospice such a godsend, whether patients are at home or in nursing homes.

The study I wrote about, by a team mostly based at the University of California, San Francisco, found ongoing repercussions from this forced decision. People were much more likely to die in hospitals or nursing homes when they used the S.N.F. benefit. Though studies repeatedly find that most people would prefer to die at home, only 11 percent did. But those who did not use S.N.F. were far more likely to be enrolled in hospice – and 40 percent of them died at home.

On the other coast, meanwhile, researchers in Providence, R.I., and Boston exploring some of the same issues have documented still other problems when people nearing death use nursing homes…

The whole purpose of Medicare’s paying for skilled nursing, recall, is to help patients get stronger and return home, or at least to improve their health. But physical therapy, for instance, may serve little purpose for those who are bed-bound, who are totally incontinent, who can’t feed themselves. “These are people who are on a decline,” Dr. Miller said. “They’re not going to get better.”

Yet they received a lot of medical interventions compared to those in hospice care. Those using S.N.F. were significantly more likely to receive feeding tubes, intravenous fluids, injections and medications — none of which can stop or slow dementia, of course, or are likely to increase quality of life…

People in palliative care and hospice have complained about this restriction for years, and they may want to keep complaining. The Affordable Care Act calls for a demonstration project of “concurrent care,” a three-year experiment allowing up to 15 hospice programs around the country to enroll patients who can also continue to receive all the other services that Medicare covers, including skilled nursing…

But the statute doesn’t set a target date, so who knows when or whether this experiment will happen? Too bad, because a lot of patients and families would like to know the answer.

I certainly would like to know. And I’m the kind of taxpayer, medicare client, who will ask.

I’m drafting an email to go to medicare.gov, my Congress critters, asking about this experiment, how and when it will be started? I suggest if you’re in the same demographic – or you have family members who are or will be – please do the same.

Yes, I feel very strongly about dying where I have lived – in my home.

French magazine reveals site of secret Israeli base


Google Earth: 31º18’31.50″ N x 34º32’35.31 E

Israel has one of the largest signals intelligence bases in the world in the western Negev, Le Monde Diplomatique reported. The base, near Kibbutz Urim, is central to the activities of the main Israel Defense Forces signals intelligence unit, 8200, the report says.

According to the report, the base has 30 antennas and satellite dishes of different sizes and types, capable of eavesdropping on telephone calls and accessing the e-mail of “governments, international organizations, foreign companies, political groups and individuals.”

One of the base’s main purposes is to listen to transmissions from ships passing in the Mediterranean, the report says. The base is also the center of intelligence activity that “taps underwater communication cables, mostly in the Mediterranean, connecting Israel with Europe…”

The report quotes a former soldier in 8200 who said her job was to intercept telephone calls and e-mails in English and French.

“It was very interesting work, which centered on locating and identifying the ‘gems’ out of routine communications,” she said.

The report says that the base’s antennas can be identified if you go to the right websites. The antennas there are lined up in rows, it says.

The author of the article, Nick Hager, is a New Zealand investigative reporter specializing in intelligence and technology related stories involving signals intelligence…Hager compares the Urim base’s capabilities to those of the U.S. National Security Agency, Britain’s Government Communications Headquarters and a similar organization in France.

“However, there is one difference,” he says at the end of the report. While those units were uncovered long ago, “the unit at Urim remained unknown until this report.”

I suppose we now have to worry about Israel bombing Paris and Auckland as well as the usual cities they threaten in the Middle East.

It gets to be a chuckle, you know, when Liberals and Libertarians both blather about eavesdropping and snooping being the sole province of undemocratic governments – and, then, they spend the rest of their time defending purportedly democratic governments that do the same damned thing.

Geek activists sniff Congresswoman’s Wi-Fi

We’re not sure what’s more humorous: That California Rep. Jane Harman, the ranking member of the House Intelligence Committee, maintains two unencrypted Wi-Fi networks at her residence, or that a consumer group sniffed her unsecured traffic in a bid to convince lawmakers to hold hearings about Google.

A representative for Consumer Watchdog…parked outside Harman’s and other lawmakers’ Washington-area residences to determine whether they had unsecured Wi-Fi networks that might have been sniffed by Google as part of the internet giant’s Street View and Google Maps program.

The group wants the House Energy and Commerce Committee, of which Harman is also a member, to haul Google executives before it, so they can publicly explain why, for three years, Google was downloading data packets from unencrypted Wi-Fi networks in neighborhoods in dozens of countries. Google has repeatedly said it didn’t realize it was storing snippets of payload data on unsecured Wi-Fi networks, until German privacy authorities began questioning what data Google was collecting.

Yup. We really need to spend taxpayer dollars to have Google state for the umpteenth time what they were doing. And why. And why they don’t do that anymore.

Consumer Watchdog’s wardriving unintentionally highlights the murky state of wiretapping laws in the United States. According to the text of the federal wiretapping statute, it’s not considered felony wiretapping “to intercept or access an electronic communication made through an electronic communication system that is configured so that such electronic communication is readily accessible to the general public.”

So even if had been deliberate, Google’s sniffing would arguably not have been illegal. For its part, Consumer Watchdog says it only grabbed frame data, not content, in order to enumerate the devices on Harman’s network…

Doesn’t seem especially murky to me. Either flavor.

Two unencrypted networks, Harmanmbr and harmantheater, according to the group, were discovered outside Harman’s residence.

Har!

Dogs sniff out inmates using cell phones

“We owe it to the victims to not allow inmates to continue to run their enterprises from behind our bars,” says Maj. Pete Anderson, who commands a canine unit that sniffs out cell phones inside Maryland prisons.

Cell phones have become the hottest contraband in prisons these days, authorities say. For $400 a pop, the phones can be used to run criminal enterprises, plan escapes and arrange for other illegal items such as drugs to be brought in.

Inmates hide the phones inside boxes of food, cutout books, in shoes with hollowed out soles and in mattresses and pillows — basically anywhere is free game to hide a cell phone, says Sgt. David Brosky, a Maryland corrections officer.

Maryland correction officials in June began one of the first programs using dogs to find the cleverly hidden phones. The program breeds and trains dogs to find cell phones hidden in the state’s prisons.

The dogs do a great job – which is no surprise.

My guess is that prison administrators don’t wish to jam cell phone communications because it might inconvenience their staff. Tough!

Of course, prison staff are the still the primo way for thugs in the slammer to get cellphones, drugs, damned near anything they want. Just pay off the screw and you get what you want.

Armpit sniffer gets jail and cane. Phew!

A Singapore man with a penchant for sniffing women’s armpits was sentenced to 14 years in jail and 18 strokes of the cane for molesting his victims…

He molested 23 women over the course of 15 months, smelling their armpits and touching them in lifts, staircase landings and their homes, the paper said. He was caught after a housewife reported him to the police.

The court meted out the jail term, normally reserved for hardcore criminals, saying the man was likely to commit crimes again.

Does the punishment fit the crime?