Every week, Kaiser Health News reporter Shefali S. Kulkarni selects interesting reading from around the Web.

ABC News: Early Burdens: Eldercare Falls on Young Shoulders

At 30, Suzette Armijo cares for her widowed 86-year-old grandmother, a retired National Park Service ranger in the final stages of Alzheimer’s disease, while holding down a fulltime job, a part-time job and raising a 4-year-old son. “This was nothing that I had planned for,” says Armijo, who moved her grandmother Elizabeth Armijo into a nearby six-bed assisted living home because veterans’ benefits “wouldn’t pay for her to live with me.” … Armijo is among a generation of young adult caregivers, the majority of whom are women, navigating tough turf without a roadmap. … As they try to tap into resources to help an ailing grandmother, Mom or Dad, these 20-somethings and 30-somethings are often on a lonely road (Jane E. Allen, 5/4).

The Atlantic: Can a Sense of Purpose Slow Alzheimer’s?

Medical professionals have also found correlations between a person’s sense of purpose and their physical health and survival. As far back as 1946, the Austrian psychiatrist Victor Frankl, who spent several years in concentration camps during WWII and lost his entire family in the Holocaust, found that the people who survived the concentration camps best were those who believed they had a reason, mission, or purpose that required their survival … [But now] it appears that a sense that your life has purpose, and that what you do matters, may actually protect your brain from the clinical effects of Alzheimer’s disease (Lane Wallace, 5/9).

Photo: PET scan by Jens Langner

Newsweek: Why The Campaign To Stop America’s Obesity Crisis Keeps Failing

Most of my favorite factoids about obesity are historical ones, and they don’t make it into the new, four-part HBO documentary on the subject, The Weight of the Nation. … the government efforts to curb obesity and diabetes avoid the all-too-apparent fact, as Hilde Bruch pointed out more than half a century ago, that exhorting obese people to eat less and exercise more doesn’t work, and that this shouldn’t be an indictment of their character but of the value of the advice (Gary Taubes, 5/7).

The Root: On Blacks And Fat: Will Allen

Obesity is more common in African Americans than in other ethnic groups. But when it comes to black people and weight, that’s where the agreement seems to end. Is food the culprit? Is exercise the solution? Is there even a real problem to begin with, or should we be focusing on health — or even self-acceptance — rather than the number on the scale? Against the backdrop of the first lady’s mission to slim down the nation’s kids, black celebs getting endorsements after shedding inches and a booming weight-loss industry, The Root will publish a series of interviews with medical professionals, activists and fitness enthusiasts that reveal the complexity of this issue and the range of approaches to it. For the fifth in the series, The Root talked to Will Allen, author of the Good Food Revolution: Growing Healthy Food, People and Communities (Jenée Desmond-Harris, 5/9).

Charlotte Observer: Nonprofit Hospitals Thrive On Profits
(5-part series/major investigation)

Hospitals in the Charlotte region have margins among the highest in the U.S. They also have billions in investments and real estate. Experts say they could do more to lower patients’ costs. …To understand what’s happening nationally, one need look no farther than Charlotte’s Dilworth neighborhood, where North Carolina’s largest hospital system got its start. Carolinas HealthCare System began in 1943 with a 325-bed hospital called Charlotte Memorial, which struggled financially for decades. Its leaders decided they needed to grow to survive. They built a system that could attract paying patients while continuing to care for the uninsured. It worked. Over the past 30 years, they have transformed it into a juggernaut (Ames Alexander, Karen Garloch and Joseph Neff, 4/21).

Medscape: New AMA Head on Membership, the ACA, and Medicine’s Future

Dr. [James] Madara: We support coverage for the uninsured; health insurance reforms, which include allowing children to remain their parents’ plans until age 26; and eliminating the lifetime cap on insurance policies. But, like any complex law, the Affordable Care Act is not perfect. For example, the Independent Payment Advisory Board, a nonelected board that could set Medicare pricing independently without accountability, is something we would not encourage (interviewed by Dr. John Reed, 5/9).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

None of the nurses interviewed could accurately explain what would happen if a patient became disconnected from a cardiac monitor — which allegedly occurred to the patient who died, according to an October 2011 report from the U.S. Department of Veterans Affairs’ inspector general.

The incident followed two deaths in the cardiac monitoring unit at a VA hospital in Denver that raised similar questions about nurse competency.

Earlier this month, a broader review by the VA inspector general of 29 VA facilities found only half had adequately documented that their nurses had the needed skills. Some nurses “did not demonstrate competency in one or more required skills,” but there was no evidence of retraining, the report said.

An outside nursing expert who reviewed the reports at ProPublica’s request called them “troubling” and said the fact that the lapses weren’t caught and corrected “signified much broader problems.”

The inspector general’s findings reveal “a lack of oversight and adherence to accepted clinical and regulatory standards,” said Jane Hirsch, a clinical professor emeritus at the University of California, San Francisco School of Nursing, who previously oversaw nursing at U.C. San Francisco Medical Center.

The April 20 IG report also noted that previous inspections had found nurse competency issues in “dialysis, mental health, long-term care, spinal cord injury, endoscopy procedure areas, the operating room and the cardiac catheterization laboratory and with reusable medical equipment.”

In a response to the inspector general, the VA pledged to create uniform competency standards for its 152 hospitals and to ensure that evaluations of every nurse’s skills are up-to-date. Nurses will not be able to work in areas in which they have not demonstrated competency.

A VA spokeswoman declined further comment.

Nurse competency has increasingly become an issue in medicine. Hospitals and clinics create their own procedures and tests for assessing the skills of nurses, but theiradherence to these policies is spotty.

Outside regulators don’t test individual nurses, but simply check if a sampling of the nurses’ files have the appropriate paperwork certifying competency.

That’s what VA’s inspector general did for the April review. As such, officials acknowledged that they could not verify whether nurses at those hospitals, or others, are providing competent care.

“We did not look at actual care or actual competence,” Julie Watrous, director of the inspector general’s combined assessment program, which inspects each VA hospital every three years, told ProPublica.

Only half the 29 facilities included in the new report had complete nurse skill assessment records that met the hospitals’ standards, inspectors found. Of the 349 nurses whose files were examined, paperwork showed that 58 lacked skills in at least one area. And for 24 in that group, there was no evidence that anything was done in response.

In an interview, however, the IG official who coordinated the report said she was generally pleased with the findings. Although both the VA and its hospitals had room to improve, she said, all of the hospitals had policies in place and at least some proof of skills in each nurse’s file.

“We never found one single site or even person that didn’t have at least components of competency assessment and validation,” said Carol Torczon, associate director of the St. Petersburg, Fla., office of the inspector general. “Where we found the holes was in the paper process.”

Torczon said she believed that the problems identified in Denver and New York were not reflective on the care generally provided by VA nurses in cardiac monitoring units.

Inspectors in the New York and Colorado cases said they could not definitely tie the deaths of the patients to their nurses’ care. But they noted that their lack of training put patients at risk.

Registered nurses assigned to telemetry units typically place cardiac leads, set parameters for the monitors tracking each patient, verify heart rhythms and take appropriate actions if there is an irregularity. They also enter progress notes and inform doctors of any changes.

After the patient in New York died, inspectors quizzed nurses and a biomedical engineer about what would happen if a patient got disconnected. “According to some staff, a ‘red alarm’ would be triggered since a disconnected lead was considered critical,” the report said, “whereas other staff told us that a disconnected lead would trigger a yellow alarm or that it would not trigger any alarm at all.”

Inspectors also found no evidence that the nurses’ competence had been checked. Records showed that one of the patient’s nurses had last received training on the monitors 13 years earlier.

Two years earlier at a VA hospital in Denver, inspectors looked into the deaths of two patients on cardiac monitors. After the first death, the hospital gave nurses a basic test of their ability to interpret monitor readings: only one of 28 passed, according to a January 2010 report. The nurse in charge when both patients died had never received specialized training in cardiac monitors.

Even after the second patient died in 2009, inspectors found “it was unclear who was responsible for telemetry training, and staff were not aware that policies had been updated.”

Both facilities vowed extensive reforms in responses that were included in the IG reports.

Experts say up-to-date competency evaluations are important because they ensure that nurses, who provide the bulk of the frontline care in hospitals, have the skills for their position.

“It would appear that the old adage ‘inspect what you expect’ has most certainly not been taken very seriously in these environments,” said Hirsch, who was chief nursing officer at UCSF Medical Center for nine years.

After reading the New York and Denver reports, Hirsch said her concern wasn’t the incidents themselves as much as that the competency of the nurses hadn’t been documented or evaluated in a long time.

Had she been in charge, the findings would have caused her “to be really nervous and want to jump on it immediately,” she said.