The National Law Review had an article about the American Bar Association’s views on forced arbitration in nursing home admission contracts.  “In a recent letter, the American Bar Association (ABA) advocates for the Centers for Medicare and Medicaid Services (CMS) to retain its current rule prohibiting long-term care facilities from entering into binding arbitration agreements with residents until after a dispute arises. In the letter sent to CMS administrator Seema Verma, the ABA writes that implementing the proposed rule would harm residents’ rights and interests.”

The ABA takes the position that the current rule follows the recent United States Supreme Court interpretation of the Federal Arbitration Act in Kindred Nursing Centers v. Clark.  The ABA states that while Kindred prohibits singling out arbitration agreements for disfavored treatment, the Supreme Court did not single out arbitration agreements for favored treatment. Trump is proposing to implement a “total embrace of mandatory pre-dispute arbitration provisions” in nursing home admissions contracts, wrote Thomas M. Susman, director of the ABA’s Governmental Affairs Office.

Beginning Sept. 11, the Brian Center Center Health and Rehabilitation, a for-profit facility owned and operated by national chain SavaSeniorCare will no longer provide services for those with Medicare and Medicaid because it failed to comply with guidelines of those programs, according to a federal government agency.  Inspections found that the Brian Center had 28 compliance deficiencies between July 1, 2016, and June 30, 2017.  According to that report, several of the deficiencies noted put residents in “immediate jeopardy.”  Brian Center had paid two fines in the last two years totaling more than $30,000.

According to a public notice from the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services, the Brian Center will undergo an “involuntary termination” of its Medicare and Medicaid provider agreement.

“The Medicare/Medicaid programs will not make payment for inpatient nursing services to residents who are admitted after Sept. 11, 2017,” the notice reads.

According to Centers for Medicare and Medicaid Services measures, the facility has a one-star rating, out of a possible five stars, on overall health care and a three-star rating for quality of patient care.

Annaliese Impink, spokesperson for SavaSeniorCare, responded to the allegations: “According to the Federal Regulations (42 C.F.R. 488.456(c)(2)), the State and/or the the Centers for Medicare and Medicaid Services must post a notice in a local newspaper regarding a pending termination of a Center’s participation in the Medicare and Medicaid programs,” Impink wrote. “The notice must be posted at least 15 days before the termination takes place.”

“Brian Center Health and Rehabilitation Center/Salisbury has requested that the Centers for Medicare and Medicaid Services approve a visit by the North Carolina Department of Health and Human Services to determine whether the violations that were cited have been corrected,” Impink continued.  “The Center is currently awaiting that visit.”

See articles at WBTV, WSOCTV and Salisbury Post.

The North Carolina Health News reported that CMS wants to regulate clauses in nursing home contracts known as pre-dispute mandatory arbitration agreements.

The Trump administration wants to not only reverse the ban, but proposes to prohibit any bans on the practice from being written into any statutes.  “The issue is that [pre-dispute arbitration agreements] are being required before any dispute has happened,” said Lori Smetanka, head of The National Consumer Voice for Quality Long-Term Care.

“When a consumer signs admission papers for themselves or a loved one into a nursing home, these clauses are often present amongst the dozens of pages of legalese in the contract. Such provisions eliminate the opportunity for a consumer who ends up in conflict with a nursing home to go to court.”

When neglect or abuse occurs, the victim only has the option for confidential arbitration, most often with an arbitrator retained by the nursing home company.

North Carolina Attorney General Josh Stein told NC Health News: “It’s fundamental in the U.S. that if a person has been harmed through the mistreatment or neglect of another that they can have their day in court. That’s what the original CMS rule provided and it’s what the new CMS rule undermines.”

A former nurse, who previously pled guilty to tampering with a consumer product, was sentenced to imprisonment for a term of 48 months.  Christina Lovern Calloway, while working as a nurse in a nursing home, diverted liquid morphine intended for patients to her own use. The defendant, on more than one occasion, took some of the liquid morphine from a bottle and used it herself. She then used tap water to refill the bottle in an attempt to hide her crime. The diluted morphine was then administered to patients.

 

NBC News reported that health care premiums will spike, insurers will exit the market, and deficits will increase if  Trump follows through on his reckless threats to cut off reimbursements to insurance companies providing coverage for low and middle class citizens, according to a new Congressional Budget Office report. Trump has said for months he is considering cutting off the cost-sharing reduction payments, which reimburse insurers for lowering out-of-pocket costs for customers.

Insurers have warned for months that cutting off the cost-sharing reduction payments would prompt them to raise premiums or stop offering plans entirely on state exchanges.

“The cost of a “silver” insurance plan would be 20 percent higher in 2018 and 25 percent higher by 2020 compared to current law, according to the report. About five percent of the population would not be able to buy insurance through Obamacare at all next year, the CBO predicted, because companies would withdraw plans in response to the “substantial uncertainty” created by the move. The markets would stabilize in future years, however, as insurers adjusted to the new policy.”

 

Politico had an interesting article on the history of Medicaid and how Republicans choose to sabotage it.

In May 1965, Lyndon Johnson signed Medicaid into law–an afterthought tacked onto the administration’s Medicare bill, and one that LBJ scarcely mentioned when he signed both measures into law. Medicaid’s roots were humble, its ambitions modest. As originally conceived, the program provided health insurance to poor children, poor pregnant women and some qualifying parents. In its first year, its budget was less than $1 billion—about $7.7 billion in today’s dollars.  Medicare and Medicaid were quintessential Great Society programs: limited in ambition in scope and designed to help groups of citizens who could not, by virtue of their age or condition, capture the advantages of prosperity.

Over 50 years, successive Congresses and presidential administrations vastly expanded the program’s scope to cover 80 million people, or almost one-quarter of the populationIts budget last year was $378 billion. Medicaid enjoyed broad backing from Republican leaders.  The Social Security Amendments of 1965—the official name of the bill that established both programs—passed Congress with bipartisan support. In the House, 65 Republicans supported the legislation; 73 GOP members opposed it. In the Senate, Republicans voted 13 to 14 in favor of the bill.

With strong bipartisan support, Nixon extended the program to include disabled adults who qualified for Supplementary Security Income and allowed states to care for those in need of psychiatric care or suffering mental disabilities.

With overwhelming bipartisan support in Congress, Reagan expanded Medicaid by sharply raising the income eligibility level for women and children, created new categories of mandatory or optional coverage, and made it easier for people who lost eligibility because of rising incomes to remain in the program during a transition period.

Republicans didn’t set their sights on Medicaid until the mid-1990s, when Newt Gingrich’s conservative revolution turned the party’s caucus to the hard right.

Now, Republicans have proposed cuts to Medicaid which will leave many millions of poor people uninsured.  For 50 years, Medicaid proved a highly elastic Band-Aid for many of America’s economic wounds.  Over two-thirds of its spending benefits children, the elderly, or the blind and disabled. It covers costs for 64 percent of seniors in nursing homes and almost half of all births. It keeps afloat hundreds of rural hospitals, whose clients are disproportionately poor and elderly.  Its desecration will leave us in an unfamiliar and dangerous place.

TrumpCare isn’t an attempt to insure more people—or the same number of people—with greater efficiency or better outcomes. It throws people off insurance to pay for tax cuts benefiting the wealthiest Americans, as Republican skeptics like Maine Sen. Susan Collins have noted.

You and I have been dreaming of this since I have been around, since you and I were drinking at a keg,” House Speaker Paul Ryan told Rich Lowry, editor of National Review. The GOP’s full metamorphosis from the Party of Ronald Reagan to the Party of Ayn Rand is complete.

Some of its leaders can’t even get their heads around the idea of insurance—the means by which people mitigate risk, together. In the year 2017, GOP members of Congress honestly wonder aloud why men should be compelled to buy into plans that cover prenatal services. Shared risk and shared reward: It’s a concept so simple—so fundamental to living in a society—that they teach it in preschool. It’s why women who have children pay into insurance plans that also benefit men who develop testicular cancer. But today’s Republican Party has grown radically anti-social in outlook.

Medicaid was designed, and by increments expanded, to help certain disadvantaged groups: struggling single parents and their children, disabled workers, impoverished older people not yet eligible for Medicare, the underemployed, the working poor. But 50 years ago, no one expected the number of people in these categories to total one-quarter of the nation. It is a testament to the program’s elasticity that it has been able to paper over the inequities of the modern American economy for so long.

Vox reported that most Trump supporters are sick of Obamacare repeal and Obamacare sabotage–60 percent of Americans think it’s a “good thing” that the Senate health care bill failed — and 78 percent expect the Trump administration to “do what they can” to make the law work better.

Even among those who identify as Republican, there is a strong expectation that it is Trump’s job to fix the health care law. 52 percent of Republicans and 51 percent of Trump supporters think that the president and his administration should “do what they can to make the law work.”

The Santa Fe New Mexican reported the history of neglect at Casa Real.  Inspections and investigations paint a troubling picture of life at the nursing home: medication errors, expired food and drugs on shelves, unreported injuries and assault, poor care of wounds, inadequate safeguards against spread of antibiotic-resistant infection, nurse understaffing and more.

Problems also have occurred at the Santa Fe Care Center, a sister facility of Casa Real, according to inspection reports.  A resident at the Santa Fe Care Center was threatened with eviction last year because his family complained about his care, an inspection found. The inspector also reported seeing staff ignore a woman’s repeated pleas for help as she sat in a wheelchair near a nursing station.

The troubles at Casa Real and the Santa Fe Care Center aren’t new. State inspectors in at least the past 15 years have cited serious deficiencies in resident care. The office of the state long-term care ombudsman, which serves as an advocate for nursing home residents, reported 428 complaints against Casa Real and 105 complaints against the Santa Fe Care Center in the past two years. The top complaints dealt with discharge, administration of medications, staff attitudes and failure to deliver ordered care.

State and federal regulators have allowed the homes to continue to operate and accept Medicare and Medicaid payments, although the facilities have faced substantial fines.  Ownership of the homes, now operated by Preferred Care Partners Management Group of Plano, Texas, has changed several times.

The for-profit facilities are the only skilled-nursing homes in Santa Fe that take Medicare and Medicaid payments, meaning area residents must accept conditions at the homes if they cannot afford private-pay nursing and want to stay in Santa Fe.

Conditions at both nursing homes are the subject of a lawsuit filed against their operators by the state Attorney General’s Office, which alleges the homes received hundreds of millions of dollars from Medicare, Medicaid and private payers without delivering even basic care.

The lawsuit alleges that Preferred Care defrauded Medicaid by having insufficient staff to meet the needs of residents at its Santa Fe nursing homes, as well as at facilities in Gallup, Las Cruces, Bloomfield, Española and Lordsburg. Also named as a defendant is Cathedral Rock, former owner of the homes.

The department conducted its last standard health inspection of the nursing home in April and reported 37 deficiencies, more than three times the average number of health deficiencies found in all New Mexico nursing homes. Among the reported problems:

• Medications were not administered at proper doses or on time. One resident was supposed to be given a medication daily but didn’t receive it on 13 days in March. Also, residents didn’t receive medications because the home didn’t have them available. Expired medications were found in drug storage.

• A female resident who was supposed to receive a shower three times a week hadn’t had a shower for a week. “I got a shower cause I was begging for it,” the resident told an inspector.

• Bathroom pull cords for call lights were unreachable if a resident fell.

• Residents were not receiving the number of physical therapy sessions ordered by physicians. “This deficient practice … is likely to increase falls resulting in bruises, lacerations, broken bones, head trauma and death,” the inspector’s report said.

• Food was not served at the proper temperature, and food in refrigerators was older than its expiration date.

Bangor Daily News published a letter from Phillip Bennett, an administrator at Bangor Nursing and Rehabilitation Center.  See below.

As a nursing home administrator, I read with great interest the BDN report “Worn to the Sole” about the Maine woman who protects the dying and can barely make ends meet. This article accurately and empathetically portrayed the daily life of a dedicated CNA in a Bangor-area nursing home. It highlighted her sincere commitment to the residents for whom she cares and the quality of care that comes from an intimate knowledge of their likes and needs, developed over months or years of daily personal attention. And it reflected her pride and confidence in working as a professional caregiver.

But “Worn to the Sole” is aptly named, reflecting the difficulties faced by CNAs in all nursing homes, where the work is hard, the hours sometimes unexpectedly long, and wages insufficient to pay the bills and provide a satisfactory living.

Maine nursing homes face an intractable CNA shortage with no precedent, and they have been struggling for some time with how to deal with it. The CNA hourly wage, adjusted for inflation, has fallen over the last 10 years — a long time during which every dollar a CNA brings home buys less — and in any case, it has never provided much more than a subsistence wage.

Together with the stress the job entails (both because of reasonable and unreasonable supervisor and family member expectations) and risk of injury (Maine CNAs are injured as often as construction workers), there has been a disincentive for CNAs to remain in the field — and they are either leaving the field altogether or for better pay elsewhere.

 As nursing homes see CNA vacancies appear with greater frequency, they turn to temporary staffing agencies, often paying twice as much to maintain minimum staffing. The agencies fill the vacancies by paying temporary CNAs a higher hourly wage. The work the agencies offer may be less certain, and benefits may or may not be available, but CNAs need a better income. Many CNAs have moved to those agencies for the higher hourly pay they receive. Many end up working in nursing homes in the same area, which are befuddled by their lack of staff and what to do about the matter. Additionally, to reduce the extraordinary and ongoing costs of temporary CNAs, nursing homes require additional hours of work on short notice, a practice all too common in health care but unacceptable in other walks of life.

It seems to me that the answer is fairly clear: CNAs in nursing homes need to be paid more. The CNA shortage is a long-term structural change caused partly by nursing homes not paying enough to attract and retain workers — a problem compounded by requiring additional shifts or weekends to cover staff shortages.

Bangor Nursing and Rehabilitation has done both — significantly increasing CNA wages and eliminating the requirement for them to stay for additional shifts. It makes no business sense to pay exorbitant fees for CNAs from staffing agencies while waiting for MaineCare, the state’s Medicaid program, to increase reimbursement rates. It is ethical and practical to pay better wages. Nursing homes already pay more for temporary CNAs than if they paid a higher wage to recruit or retain their own staff. Not to do so flies in the face of reason, regardless of state legislative action.

Our experiment is early. We still have unexpected turnover, but we do receive more applications for vacancies and fill them faster than before, and have greater employee satisfaction by not mandating additional hours. We also hope to improve our retention by offering better wages and not requiring our employees stay beyond their scheduled shifts.

Perhaps an independent nonprofit can do this easier than a corporate for-profit entity, but this change is inevitable. The sooner CNAs make more and have reliable hours, the more likely nursing homes will be able to reduce their dependency on staffing agencies and reduce their wage expenses. In the process they will likely find satisfaction in caring for their employees as those employees care for their residents. It is the right thing to do.

 

KTLO reported that additional charges have been filed against a nurse who fled from law enforcement officers earlier this month following a traffic stop after police responded to a complaint of an intoxicated driver on July 16. When they located the vehicle and attempted to conduct a traffic stop, the driver refused to stop, and a short pursuit ensued.

The driver, Geneva Liveley, was apprehended and taken into custody. An inventory of the vehicle revealed numerous prescription medications belonging to other individuals, a loaded firearm, drug paraphernalia and cash totaling $1,110.

Liveley was charged with simultaneous possession of drugs and firearms, possession of a controlled substance (Hydrocodone), both felony counts, as well as misdemeanor charges.

Chief Manuel says an investigation began into Liveley’s possession of prescription medications belonging to other individuals. It was learned she worked at a local nursing home and stole medications from residents. The medications in her possession were logged by her as being received by the residents.

Liveley was arrested again and charged with four felony counts of controlled substances-fraudulent practices and six misdemeanor offenses.