Mastodawn

The Guardian: Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers

"...The company also monitored nursing homes that had smaller numbers of patients with “do not resuscitate” – or DNR – and “do not intubate” orders in their files. Without such orders, patients are in line for certain life-saving treatments that might lead to costly hospital stays.

Two current and three former UnitedHealth nurse practitioners told the Guardian that UnitedHealth managers pressed nurse practitioners to persuade Medicare Advantage members to change their “code status” to DNR even when patients had clearly expressed a desire that all available treatments be used to keep them alive...."

https://www.theguardian.com/us-news/2025/may/21/unitedhealth-nursing-homes-payments-hospital-transfers

#insurance #greed

Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers

A Guardian investigation finds insurer quietly paid facilities that helped it gain Medicare enrollees and reduce hospitalizations. Whistleblowers allege harm to residents

The Guardian

Eric Lawton 2d ago

Wait!
I thought it was public health care that had bureaucratic "death panels".

Sarah Palin said so!

https://en.m.wikipedia.org/wiki/Death_panel

@bonaventuresoft

Death panel - Wikipedia

Layla Low 2d ago

@ai6yr Saw this on Bluesky & came here to report that, although I haven’t got UH Insurance, my primary care doctor asked me to sign a DNR at my yearly office visit late last year.

I’m extremely careful about staying healthy, and quite active for someone in their 70s. I couldn’t figure out what was up with that until this. (1/2)

Layla Low 2d ago

I was asked to sign a POLST, which is an Oregon program widening the reach of DNRs for frail people who are basically at death’s door and couldn’t withstand CPR.

Maybe the doctor just made a mistake & confused me with someone else, but either way it was weird and not inspiring of trust (2/2)

AI6YR Ben 2d ago

@nesmb YIIIIIKKKEEEESSSS

MsMerope 2d ago

@ai6yr @nesmb
As an EMT I will have a DNR here in a few years.
Getting ROSC in the field is what 10-15% ?

Cracked sternum/ribs?

ICU/CCU complications and dementia?

No thanks.

MsMerope 2d ago

@ai6yr @nesmb
Folks might want to consider
five wishes
I need to redo mine…

https://en.wikipedia.org/wiki/Five_Wishes

Five Wishes - Wikipedia

MsMerope 2d ago

Bummer, you can’t just print them out anymore.

Jim Hubbell 2d ago

@MsMerope @ai6yr @nesmb
Having been through the process of dying with both my parents, I have two comments.
1) Talk to your loved ones about their wishes. Make sure everyone in the family knows what they are because it's entirely possible in the moment of need the primary decision maker will not be available.
2) Write it down in the form legally required in your state and have multiple legal copies. When Dad was dying, the only legally signed copy was 400 miles away.

Pomegranate_Stew 2d ago

@MsMerope @ai6yr @nesmb
Same. After watching what my fil went through the last five years of his life due to two resuscitations, my parents now each have one and I plan to.

AI6YR Ben 2d ago

@nesmb Oh wow 😱

Mathaetaes 2d ago

@nesmb @ai6yr Did they ask you to sign a DNR, or did they just give you the Advanced Directive information sheet?

I received my first Advanced Directive information sheet from my doctor at like 30. Granted, it was when I was there for a cancer diagnosis, but the 5-year survival rate for what I had was like 98%. I didn't get the impression that they were encouraging me to sign a DNR - just that they were encouraging me to think NOW about what conditions I'd want to be kept alive under. It's an important thing to think about when you're healthy so your family doesn't wonder about it when you're sick. If you're in a coma and unlikely to wake up, do they keep you on life support? Do you want to continue if you'll be confined to a bed, eating from a feeding tube, and needing to ask for help to go to the bathroom for the rest of your life? Do you want to continue if you'll be in constant, severe pain? Do you want to live with missing limbs? Cognitive decline? Would you want to continue in a vegetative state?

Also, the answers may change over time. Now that I have kids, the conditions that I'm willing to tolerate are far more severe than in my 30s. I still think I get too many of these "have you considered an Advanced Directive" info sheets, but their value is worth their annoyance. Death is a hard topic, and most people won't think or talk about it without prodding, but it's an important conversation to have. A good health system will be encouraging people to have those conversations with their friends/family, without attempting to influence the conversation beyond providing medically sound information.

The issue with United Health is that they were pressuring nurses to influence those decisions, and to do so in a way that increased profits regardless of a patient's true feelings. That's truly vile, and should be criminal.

Robin Barton 2d ago

@ai6yr Well, that takes ethics to a lower level than before. I think the management could do some good work in Israel helping with the ethnic cleansing and genocide.

pagangod (he/him)2d ago

@ai6yr First and foremost, that is incredibly shitty and unethical. Burn private health insurance to the ground with holy fire.

That being said: I've been through the decade of eldercare, and I can say that DNR/POLST is actually a good idea. I believe I read that the majority of medical practitioners and emergency medical staff have DNRs, because it actually rarely turns out well. An electrical shock stops your 36-year-old heart and they just need to restart it? Sure. Your heart stopped because you threw a clot because you have coronary artery disease, heart failure, and pulmonary edema issues and you'll need 2 weeks in the ICU, which can mess you up medically all by itself, in the best possible outcome? Sure they *could* keep you alive until you skin begins to bloat because of poor circulation . . ..

Please get a realistic take on end-of-life care from a trusted medical professional while you can still make decisions for yourself. Families often hang on when they should really let go.

AI6YR Ben 2d ago

@pagangod Yeah, I have a first responder in the family, and there are definitely times they advise a family that CPR and extensive measures are just prolonging suffering. (like you said, someone with multiple existing issues, cancer, etc. and CPR is just a brutal way to extend life for a day or two).

Katherine W 2d ago

@ai6yr @pagangod

In the late 1990's, my father was in the ICU of a small hospital, with pneumonia due to his late-stage leukemia. One of the nurses took my mother and me aside. She said that he didn't have any directive for care in a health crisis, which meant that if he had a heart attack, she and the care team would work to resuscitate him.

This initially sounded good to us, he wasn't in a lot of pain, was weak, but conscious and cognitively pretty intact--so, more time to spend with him...

Then she explained that she would be giving my father CPR, which would be pretty brutal for a 70-some year old man who was fairly frail. She said he would likely have a lot of internal bleeding in his chest and abdomen because of the poor clotting that is an effect of leukemia. She said it's not uncommon for ribs to break during CPR, and that quite honestly, he would probably not be physically strong enough after that to leave the hospital to die at home, which was his wish.

She suggested that my mother and I think and talk about that, together and with my father, and decide what would be best for him. We did discuss all of that, and chose DNR status.

Obviously, there is a great difference between a patient and their family making that decision and an insurance company deciding for patients without their input/consent. I would never be in favor of that decision being made without taking into account the patient's desires, but I also think it's important to have all the facts...

That discussion with Nurse Dorothy was difficult, but we were so glad to have an understanding of the likely outcome of a full code resuscitation so that we could all decide what would be the best thing for my father.

@FiddleSix @ai6yr @pagangod My father-in-law had an advance directive, but during his decline he was in and out of the hospital several times, and every time, the hospital claimed they didn't have it on file. Make sure you check, and be ready to give them a copy.

tuban_muzuru 2d ago

@jhavok @FiddleSix @ai6yr @pagangod

I was the last family member to arrive at my brother's bedside. Quiet, no crying. I sat at the head of his bed and read him JRRT's Road Goes Ever On. wished him a good journey.

More morphine, less oxygen. They turned him off. Nobody cried except his wife and she was comforted there.

We need to approach death without terror, knowing there are good deaths.

https://tolkiengateway.net/wiki/The_Road_Goes_Ever_On_(song)

@tuban_muzuru @FiddleSix @ai6yr @pagangod My father-in-law had specified he didn't want to be kept alive with tubes, so when his kidneys shut down while he was unconscious from a heart attack, we said no to dialysis. The hospitalist actually cried while trying to persuade us to go against him. They kicked back in by the next morning and he was home in another day. Some months later, he refused hospital treatment...doctor said "if you do this you'll die" and Bill played a tiny violin for him.

Katherine W 2d ago

@jhavok @ai6yr @pagangod

When we filled out the POLST for my mother, we were instructed to keep it posted on the refrigerator, so if she were taken by ambulance, we could grab it to go with her.

Now, in Oregon at least, they are digitized and filed with the state, so, theoretically, available at all hospitals. I haven't checked to see if that's actually the case, but should.

Anne Ominous 2d ago

"health care"

what a horrible joke.
it's so bad, i'm just gonna die of whatever disease i get. i havent seen a doctor in over 10 years.

Snippety Snap (she/her)2d ago

@ai6yr
#FreeLuigi

@ai6yr UnitedDeath

Matt Blaze 2d ago

@ai6yr Holy crap. While DNR orders are certainly a best option for many people, you need to have confidence that the advice you're getting from your health care providers is based on your best interests, not that of an insurance company. This is ethically beyond the pale.

Paul_IPv6 2d ago

more and more, they are getting caught showing that they are the health *insurance* industry, not a health *care* industry, and that shareholders, not patients, are who they are concerned about.

AI6YR Ben 2d ago

@paul_ipv6 Plainly obvious to most folks who have to USE that health insurance... just egregious here on the way they go about attempting to avoid costs.

Paul_IPv6 2d ago

it's pretty obvious to me that universal health care for all is not communism or socialism or government over-reach. it's the only path to safe, affordable actual health care for everyone in this country. private health care is the death panel the GOP love to rail on about.

samiamsam 2d ago

wow

Grumble 🇺🇸 🇺🇦2d ago

@ai6yr I'm all for people managing their own end of life care and making hard decisions in advance.

I'm strongly opposed, maybe violently opposed, to for-profit corporations managing it for them.

Luigi Mangione and UnitedHealth - putting the executions in the executive suite where they belong.