Tube Feeding Depends On The Attitude Of The Facility

By the year 2030, the number of people in the United States over 65 will soar to 71.5 million. The healthcare industry is keeping pace by providing communities with the housing and care resources needed to accommodate the nation’s aging population. Independent, assisted living and memory care facilities are oftentimes located on the same property and are known as Continuing Care Retirement Communities.  At a CCRC, residents can move within the tiers as their conditions may change over the years. Many assisted living facilities are also stand alone homes that frequently have wings for providing memory care to those residents with loss of cognitive skills such as those with Alzheimer’s disease or other forms of dementia.

Tube feeding is a procedure used in acute care hospitals for patients recovering from certain surgeries, those with neurological problems, some going through intense chemotherapy or for any reason, are unable to receive proper nutrition by swallowing. Feeding tubes, or the medical term, Percutaneous Endoscopic Gastrostomy, (PEG), are frequently utilized to provide nutrition for the elderly. Many of these elderly patients reside in assisted living facilities and skilled nursing facilities. Though the procedure is fairly routine medically, there are many complex issues surrounding PEG use, particularly for patients near the end of life, where the decision to use or not to use a PEG is frequently made without the participation of the patient.

The ethical picture is further clouded by several studies that question the medical benefit of PEGs in elderly demented patients, a group that receives a high percentage of the PEG procedures currently done. Other studies have found a surprisingly high death rate for those patients within one month of a PEG insertion. Tube feeding has been shown to have no demonstrable benefit in assisted living or skilled nursing patients with advanced cognitive impairment, yet its use within this population reveals a striking and unexplained variation within the United States.

Half complete memory by *Jangmai on deviantART

The Journal of the American Medical Association has published a report on a study of patients with advanced cognitive impairment and found that 70% of feeding tube insertions were done in the acute care hospital prior to the patient being moved to an assisted living facility. The study suggests that higher insertion rates are associated with the following acute hospital factors:

For profit ownership vs. government owned
Larger size vs. smaller size (more than 310 beds vs. less than 101 beds)
A more aggressive approach to end of life care, meaning greater use of the intensive care unit in the last 6 months of life as opposed to a memory care facility or hospice.

A field study was also done in two South Carolina assisted living facilities. Field studies are based on the idea that humans are best understood to the fullest possible context if it includes the place where they live, the improvements they’ve made to that place, how they are making a living and providing food, housing, energy and water for themselves or others, what language(s) they speak and so on. The study revealed a startling variation in the culture of the organizations and its influence on attitudes toward tube feeding. Key features in assisted living facilities with low use of feeding tubes:

A more home like environment in which food, mealtimes, and family are central.
Administrative support in solving feeding problems.
Emphasis on the value of, and sufficient staff for hand feeding.
Family inclusion in decision making.

In contrast, the high use feeding tube facility had an impersonal, institutional atmosphere with strictly scheduled and poorly staffed mealtimes.  Staff attitudes favored tube feeding, and though the decision making process was not clear, it emphatically did NOT include family. If you are considering a Continuing Care Retirement Community or a standalone assisted living facility that most often includes a memory care wing for the cognitively impaired, it is essential to ask about their policy on tube feeding. Using an experienced, qualified referral service to assist you in the process, can help you determine the attitudes and policies of the organization where you or your loved one will reside.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Philadelphia and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.