health services - Bill of Health

Senior citizen woman in wheelchair in a nursing home.

The Barriers to Aging in Place

October 29, 2021October 29, 2021 The Petrie-Flom Center Staff Leave a comment

By Renu Thomas and John Roth

The COVID-19 pandemic has highlighted the risks associated with institutionalized care for the elderly, and has further shifted sentiments toward a preference for aging in place. But most seniors and their loved ones don’t realize the barriers that make aging in place a difficult proposition until a crisis occurs and they’re faced with finding services.

Take our family, for example. My father was diagnosed with Parkinson’s disease and it was after his first fall and discharge from the hospital that our family realized my parents’ independence was severely limited. We knew their house was not wheelchair or walker accessible, but we also needed to address other issues as well; neither of them could drive anymore, so how would we get them to appointments, how would their prescriptions and groceries get picked up, and how could we prevent them from being socially isolated? Like many families, we do not live nearby, let alone in the same state, which made coordinating these services even more challenging.

Temporary entrance in front of New York hospital during COVID-19 pandemic.

Institutional Reforms Needed to Strengthen Health Care Post-Pandemic

April 14, 2021April 15, 2021 The Petrie-Flom Center Staff Leave a comment

By Marissa Wagner Mery

COVID-19 has highlighted that pandemic preparedness and management requires a strong, well-functioning health system.

Shoring up the health system and its workforce should be a national priority post-pandemic. First and foremost, we must recognize that the greatest asset of the health system is its people, and the system must reflect this. Second, our hospital-based, competition-driven health care landscape should be reformed to better meet the needs of our communities.

How Preclinical Medical Students Have Embraced Advocacy Amid Virtual Education

April 13, 2021April 12, 2021 The Petrie-Flom Center Staff Leave a comment

By Tarika Srinivasan

On February 28^th, 2020, after an hour of incessantly refreshing my email inbox, I received an acceptance letter to my dream medical school. That same day, a conference in the city I would soon call home became the superspreader nexus from which up to 300,000 COVID-19 infections have been traced.

The ensuing months, which were meant to be an exercise in pomp and circumstance, were marked by a steady stream of anxiety, frustration, and disappointment associated with virtual learning.

As first-year medical students, it is hard not to feel that we comprise the bottom rung of a long, rigid hierarchy. We are fully aware of the limited role we play in this pandemic; we lack the useful clinical skills of a final-year medical student or an employed resident. Our presence in the hospital is more of a liability than an asset.

We witnessed classes of fourth-years graduating early to serve on the front-lines of the spring first wave (though reception to this call of duty ranged from appreciation to apprehension). We imagined that in a few short years, we too might be deemed so “essential” that folks would be clamoring to have us serve on the wards.

But, despite our limited skills, we preclinical students decided we could not simply wait in the wings for our cue. Though we were dedicated to the didactic portion of our curriculum, we were itching to be involved in the action. Thus, we sought to expand the scope of what medical students could do during a pandemic.

Physical therapist helps person in wheelchair.

How the COVID-19 Pandemic Has Changed Caregiver Education and Training

April 9, 2021April 8, 2021 The Petrie-Flom Center Staff Leave a comment

By Elizabeth Hansen

As a Physical Therapy Practice Leader, I help patients at the rehabilitation level of care — patients who have sustained a significant injury or disease that has life-changing implications.

Caregivers play an important role in the discharge of these patients from the in-patient context back to the home. They take on the burden of learning the techniques and interventions recommended by the clinical team. They may be learning how to use and maintain new equipment, such as power wheelchairs, feeding tubes, and lifts.

During the COVID-19 pandemic, I have noticed increased distress among both health care providers and family caregivers as patients are getting ready to discharge home, due in large part to challenges posed by the pandemic to family health care education.

DUQUE DE CAXIAS,(BRAZIL),MAY,20,2020: doctors take care of patients with covid-19 and an intensive care unit (ICU) at hospital são josé specialized in the treatment of covid-19.

From Pain to Progress: Nursing After the Pandemic

April 8, 2021April 7, 2021 The Petrie-Flom Center Staff Leave a comment

By Victoria L. Tiase and William M. Sage

America’s nurses are a powerful force for good — four million strong, universally trusted, increasingly diverse, serving every community across the country, with an overall economic impact greater than the total output of the median American state. However, the pain of pandemic nursing is real and widespread. Urgent attention to nursing’s vulnerabilities is required for the profession to help the U.S. emerge from the confluence of the worst public health crisis in over a century and the most severe economic decline since the Great Depression.

ANDOVER,HAMPSHIRE/UNITED KINGDOM-NOVEMBER 6 2019:A district nurse visits a ninety-four year old patient at his home to treat for pulmonary edema and head/brain injury.

Challenges Facing Home Health Caregivers During COVID-19 Pandemic

April 7, 2021April 6, 2021 The Petrie-Flom Center Staff Leave a comment

By Vicki Hoak

The pandemic has emphasized the value of home health caregivers. Their contribution has been overshadowed for decades, but now it is very clear how important their work is to the well-being of older Americans, people with disabilities, and medically-fragile children.

As families were urged to stay at home to stop the spread of COVID-19, home care agencies and their staff became all the more important for preventing the spread of COVID-19 and protecting the most vulnerable from the disease. Home health aides offer clients one-to-one care and continual monitoring of changes in conditions — all in the safety of one’s own home.

How COVID-19 Has Widened the Experience-Complexity Gap in Nursing

April 6, 2021March 31, 2021 The Petrie-Flom Center Staff Leave a comment

By Julie Miller

I am a Clinical Practice Specialist for the American Association of Critical Care Nurses (AACN), and I have noticed the experience-complexity gap widening during the pandemic. As increasing numbers of nurses retire due to the stress of serving on the front lines, novice nurses are tasked with complex caseloads.

Hospital-based educators tell me they do not have enough experienced nurses to oversee and mentor the novice nurses due to attrition, as experienced nurses are taking advantage of high paying travel contracts, or are leaving the ICU/PCU specialty due to burnout, moral injury, and post-traumatic stress.

Post-pandemic, the experience-complexity gap for progressive and critical care nurses will continue to widen and affect intensive care unit (ICU) and progressive care unit (PCU) orientation and ongoing education.

Field hospital in NY during COVID-19 pandemic.

Ethical and Legal Challenges Faced by Hospitals in New York’s First COVID-19 Surge

April 5, 2021March 31, 2021 zshapiro1 Leave a comment

By Zachary E. Shapiro

After COVID-19 reached the United States, New York City quickly became the epicenter of the pandemic. Clinicians at New York Presbyterian Hospital-Weill Cornell Medical Center turned to the Clinical Ethics Consultation Service to help meet the ethical challenges that arose. During the surge, the Ethics Team saw a marked increase in the volume of consultations for individual patients in the hospital, and took part in over 2,500 informal consultations with caregivers. Discussions centered around a wide range of ethical issues distinct from those that come up in routine practice. As one of the only lawyers in the Division of Medical Ethics at Weill Cornell Medical College, I encountered a myriad of legal concerns presented by the pandemic.

During the height of the surge in New York, there was no formal legal guidance available to clinicians concerning medical practice during a pandemic. Questions about legal immunity abounded, as unclear state and federal guidance left many doctors worried that they were taking personal and professional risks by providing care to COVID-19 patients.

The pandemic forced doctors to shift away from traditional standards of care in terms of resuscitation, patient care, and surrogate decision-making. The ethics team had to take new dynamics into account, such as the risk of infection to doctors and staff, and balance these factors in the risk/benefit calculations for treatments and interventions. Undertaking these shifts without federal or state guidance caused significant distress and concern. It often seemed that the law was not only not helpful, but an active hindrance to medical practice, as many health care workers were consumed by worry about the prospect of future liability. This concern persisted, even though the deviations in the standard of practice were necessitated by the realities of the pandemic overwhelming our health care system.

woman with iv in her hand in hospital. Labor and delivery preparation. Intravenious therapy infusion. shallow depth of field. selective focus

Protecting Patients and Staff in Labor and Delivery During the COVID-19 Pandemic

April 2, 2021March 31, 2021 The Petrie-Flom Center Staff Leave a comment

As a labor and delivery nurse, I see patients at their most vulnerable and am there for them during an incredibly intimate time. After thirteen years, I am still awed and amazed at each birth I am lucky enough to be present for.

But in March of 2020, everything I knew as a nurse changed when COVID-19 reached my small community hospital.

Our struggles were two-fold — making our patients feel safe and making our staff feel safe.

A Medical Student Reflects on the Value of Time During the COVID-19 Pandemic

March 31, 2021March 30, 2021 The Petrie-Flom Center Staff Leave a comment

By Jess Ma

He passed away on the 107^th day. After I got home in the evening, I wrote down everything I could remember about him in my journal. For many days after his death, I often dreamed I was standing in that fluorescently bright ICU room. In the dreams, I would be watching him, and then he would wake up and start speaking to me, with those bright blue eyes glittering with animation and life. I always awoke feeling a little unsettled, not by his death, but rather by the fact that I knew so intimately the ways in which he was kept alive, and yet nothing about the life he lived until just hours before his final breath.

He was an existing patient on the unit when I joined the surgical ICU team, and for 10 days I followed him, tracking how every organ system was doing each day. Everyone on the team knew there was only one way this would end; his quality of life had deteriorated so rapidly since the early summer, after a bout of necrotizing pancreatitis and multiple tragic complications; he was barely able to interact with his own body, much less his environment, and his life was propped up precariously by every possible machine that could perform the function of a vital organ. For him, no medical intervention would add more significant chapters to his story. It was just a matter of when his daughter would be ready to close the book.

Because of the pandemic, visitors were only allowed after 12pm each day. When his adult daughter came to visit each afternoon, I was told to avoid intruding on their cherished private time together. I only ever really saw her shadow behind the drawn curtain as I walked past the room; and I knew that one of the surgeons on the service (a group of surgeons rotated between trauma, acute care, and surgical ICU) would routinely give her calls or meet up with her to discuss how her father was doing, even on days he had off. Surgeons are not generally thought off as doctors who can spend a lot of time just talking to patients – after all, in the time he spent on one of those daily conversations, he could complete an appendectomy. Though neither he, nor the rest of the team, could offer a magic solution, what he offered was crucial – his time.

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