Ann O’Leary, Director of the Children and Families Program at The Center for the Next Generation and Lecturer, Berkeley, School of Law, wrote an article called "The Real Health Care Train Wreck"
addressing the impact of rising health care costs on our next generation (today’s kids).  Below are some excerpts:

Rising health care costs are affecting all of us, and if we don’t control them, health care will consume our family budgets, as well as our government budgets with little left for investing in the next generation.

Consider these facts:

Children and Families. Families are losing the ability to save for a child’s college fund or for retirement. In 2010, health care costs rose to more than 21 percent of the household budget from 9 percent in 1969. In the past ten years, alone, premiums for employer-sponsored health insurance doubled. While 42 percent of low-income children and working-age adults had employer-sponsored coverage in 2001, only 24 percent had it in 2011. In some cases, the decline led to personal bankruptcy.

State and Local Governments. Medicaid has now replaced education as the largest state budget expenditure, accounting for about 22 percent of state spending. In the 1980s, elementary and secondary education was the largest share of state spending, followed by higher education. Since 2007, Medicaid has been No. 1. Of course, part of this is good news — Medicaid has been expanded to cover many more children. But other reasons for the cost increases are more troubling, including soaring health care costs and declining employer coverage.

Federal Government. At the federal level, Medicare, Medicaid and the Children’s Health Insurance Program make up 21 percent of the federal budget, with Medicare accounting for two thirds of it. This share of the federal budget is expected to continue to increase, squeezing out funding for other critical investments in the next generation. Just consider the last five years alone: spending on children’s health increased by 32 percent at the federal level while spending on education increased only by 7 percent.

It is no wonder that both parties are trying to find ways to cut health care costs.

But the vital question on the table is how we can keep our commitment to providing for the well-being of our most vulnerable — children and elders — while making sure we have enough resources for the programs that sustain the country’s next generation?

This is not an easy problem to solve, but it is a problem for which all of us should be demanding solutions, not partisan posturing. Too often, Medicare is understood by politicians and the public as a program that only affects seniors and Medicaid is seen as a program that only deals with poverty. In truth, these programs have a greater impact on our government’s ability to invest in the next generation than any other.

Here are three things to keep in mind as you follow the debate about health care costs:

First, the Supreme Court’s actions are only part of the story. While requiring all Americans to hold health insurance will ultimately increase access and drive down costs, it is not the only cost control mechanism in the Affordable Care Act. As long as the Court doesn’t strike down the entire ACA, health care costs can still be constrained through the reforms left standing.

Second, Medicare drives a tremendous amount of federal spending, crowding out our ability to invest in other programs. That is why the Medicare Independent Payment Advisory Board is so critical and why the House vote to eliminate it is so dangerous. As proposed, the board cannot control costs through rationing care, increasing taxes, changing Medicare benefits or eligibility, or increasing premiums. Rather, it would need to be creative, expanding upon delivery system reforms that drive down costs while maintaining the commitment to covering all of America’s elderly. It could save the country more than $15 billion over the next ten years.

Third, proposals, such as those offered in the Republican budget that drastically cut Medicare and Medicaid by billions of dollars will necessarily result in rationed care and fewer eligible beneficiaries. To keep our core values focused on covering nearly all of America’s kids and seniors, we need to engage in real conversations about reducing the price of health care. Doing so might shrink profits for the health industry, but it will lead to greater quality of care while keeping our commitment to coverage.

No matter what — Americans should ignore the din of partisan shouting to focus on this crucial problem.

And don’t let anyone convince you that Medicare is only a senior issue. It may be the most important children’s issue facing our nation.

 

 

An article from Chico Enterprise Record states that lawsuits have been filed in the deaths of two patients of Lifehouse Cypress Healthcare Center.  The families of the late Donald Dey Sr. and Mary Gustavson are suing for negligence, violations of the health and safety code, and wrongful death.

The first complaint states that on Jan. 12, 2011, Dey was admitted to the hospital for treatment of an infection and kidney disease. After Dey’s condition improved, he was transferred to Lifehouse Cypress for a short stay while they arranged for a home health care nurse to attend to him at home. Dey was admitted as a high risk for falls therefore necessary precautions were needed.  Dey was taken to his room and left alone in his bed.  Less than half an hour later, Dey was found unconscious on the floor with a head injury. He died two days later as a result of swelling of the brain.

In the second case, Gustavson was transferred to Lifehouse Cypress on Feb. 2, 2011, for short-term rehabilitation.  The hospital told the nursing-home staff that Gustavson was to be given doses of morphine sulphate and Xanax "TID."  "TID" is an abbreviation of Latin words that mean "three times a day."  The complaint says the nursing home staff gave Gustavson the two medicines at 9 a.m., 1 p.m. and 5 p.m. daily, while her doctor intended her to have them at eight-hour intervals.  This overmedication caused Gustavson to suffer distress and hospitalized with a diagnosis of morphine overdose.  She died a few days later of  "acute renal failure" caused by the overdose of drugs at the nursing home.

Both of these cases never would have been filed if the facility had an adequate number of qualifed and well-trained staff.  These incidents were certainly preventable.

 

The Republic reported that advocates for the elderly are objecting with Kansas Gov. Sam Brownback’s choice of Barbara Hickert to be the state’s long-term care ombudsman, raising concerns that consumers’ best interests will be ignored, and abuse and neglect will be covered up.  This is the third person coming from the nursing home industry to hold the post.  Brownback has appointed several people with nursing home ties, including Aging Secretary Shawn Sullivan and Joe Ewert as commissioner for licensure, certification and evaluation. Sullivan was a Wichita nursing home administrator and Ewert worked for LeadingAge Kansas.

"I’m not overstating it, it’s life or death," said Mitzi McFatrich, executive director of Kansas Advocates for Better Care. "Right now, there’s a heavy weight on the provider side. The concern is that consumer needs will be second to industry."

It’s extremely rare for someone from the nursing home industry to be appointed as state ombudsman.  Mark Miller, the ombudsman for New York and vice president of the National Association of State Long-Term Care Ombudsman Programs, said "I can’t think of a single colleague. I think that’s something the average person would have a question about," Miller said. "’Where do this person’s allegiances lie?’"

.

 

 

An article in the ChilicotheGazette rightly questions a nursing home’s decision to accept a potentially dangerous incompetent resident.   Competing public policy decisions arise in these situations:  The right of the incompetent resident to receive care versus the right of other residents to be protected,

The article references the tragic case of 53 year old John Stroud who was arrested after shooting at Scioto County deputies in 2011.  After being found not competent to stand trial, he was placed at the Health Nursing Care Center at the request of his family.   He escaped confinement forcing nearby schools to lockdown and placed nursing home residents at risk.  The care facility consists of a locked unit for patients requiring a secure environment.  However, even under lock down in this setting, patients have the right to sign out or be signed out by a family member. These units are hardly the place for dangerous and deranged residents.

The Health Nursing Care Center admits it does not contain a psychiatric ward suitable for dangerous residents such as Stroud.  Individualized care plans, specialized personnel and increased security is needed before such a patient can be accommodated. According to Dustin Ellinger, chief of the Bureau of Long Term Care Quality at the Ohio Department of Health, if a facility lacks any of these necessary accommodations, it may and should turn down accepting residents such as John Stroud.

The Health Nursing Care Center is one among many nursing homes ill-equipped to handle the mentally impaired yet is forced to make up for the lack of state resources needed for such individuals.  Locked units are common across the states but often have become a dumping ground for the mentally ill.  These facilities take on dangerous residents suffering mental illness as there is no requirement of a special license.  Also missing are laws regarding the housing of residents with a criminal history.

Stroud was not the facility’s first mentally ill resident facing felonious charges. The home took on a federal prisoner several years ago who assaulted three residents before being removed by U.S. Marshalls. Nursing home facilities have locked units for patients suffering from dementia or late stage cognitive impairment.  If a resident strays from the area, they are treated as a missing person rather than a fugitive.  Further, these special units have been described as lonely hopeless environments. 
 

Interesting editorial from Paul D. Carrington (law professor at Duke) for the NY Times about the power and influence of the Supreme Court, and judicial term limits. 

"The idea isn’t new. High-ranking judges in all major nations, and all 50 states, are subject to age or term limits. The power to invalidate legislation is, in a sense, the ultimate political power, and mortals who exercise it need constraint. So why not the highest court in the land? "

"Indeed, Mr. Perry wasn’t the first person to propose adjusting the political powers of our highest court, nor is the idea an exclusively conservative one. In 2009 a politically diverse group of law professors, including me, proposed a system that would work around the need to amend the Constitution — an extremely unlikely possibility — yet still capture the benefits of term limits."

"Here’s how our plan would work. Every two years the president would appoint a new justice to the court, but only the nine most junior justices, by years of service, would sit and decide every case.  The rest would then act as a sort of “bench” team, sitting on cases as needed because of the disability or disqualification of one of the junior justices. These senior justices might also help decide which of the thousands of petitions the court receives each year should be fully considered, vote on procedural rulemaking, and perhaps sit on occasional cases presented to lower circuit courts."

"If five of our present justices broadly prohibit the federal government from providing accessible health care, Congress should consider using its constitutional power again to add two more justices — and impose a reasonable limit on the length of time that a mere mortal should hold so much political power."

 

John Christopher Fine served as senior assistant district attorney in New York County, director of the Organized Crime Task Force, and special counsel to a U.S. Senate investigating committee.  He served as special counsel to the U.S. Senate Aging Committee and investigated fraud and abuse in public assistance programs.  He recently published an article in The Epoch Times on the widespread waste, fraud, and corruption in the nursing home industry.

"Our undercover operations proved that not only was the medical care poor but government programs were being ripped off by unscrupulous providers. When it came to nursing homes, only one, in all we investigated, delivered appropriate care."

"On some occasions when I visited nursing homes and assisted living facilities I was appalled at the lackadaisical attitude of staff. Taking care of long-term nursing home patients is a difficult occupation. Doctors come and go. Many are prejudiced against the elderly."

"Too many physicians chalk sick and elderly off as being near death and thus unworthy of their time and devotion. They spend seconds with a patient, often only the minimum to be able to bill that patient’s insurance provider or Medicare."

"Licensed nursing staff is limited and rotates. The dirty work is left to immigrant labor. They take minimum wage jobs, have limited skills, and no interest in the patients themselves."

"Incidents of abuse and neglect are rampant in nursing homes and assisted living facilities. One chain in New York was owned by the same person. Of all things he was a Rabbi. He was a villain. His nursing homes were filthy, the patients’ care poor, and the fraud perpetrated criminal. Some of his nursing homes even continued to bill government programs for patients long after they died."

"Abuse is rarely if ever detected. A patient can fall, slip, an intravenous drip can go wrong. Many are old and their memories cannot be depended on to relate what has happened to them. Some suffer various forms of dementia making their care even more difficult." 

 Be sure that aides see you and understand your relationship with the patient. Let them see that you are and will be on top of the care given. No matter the facility a patient’s advocate is the best way to insure honest and competent treatment in any nursing home or assisted living facility. Good ones welcome it

 

 

The Health Blog on the Wall Street Journal’s website had an interesting article on cutting health care costs and providing better care in the process.  "A better approach to advanced illness, including fewer hospitalizations, could improve quality of life and satisfaction for the sickest patients — and save $25 billion in annual health-care costs, according to Gundersen Health System.  Gunderson advocates helping patients and families prepare for end-of-life decisions, and avoiding unwanted treatments while providing comfort and pain relief.

Gundersen’s Respecting Choices program is a model for how hospitals, insurers, and patients and their families can work together to make sure people with advanced illness get the quality of care they want and have their wishes for treatment respected.

Part of the program includes having patients and physicians fill out a form known as a POLST — for Physician Orders For Life Sustaining Treatment. This is an initiative that lets people with advanced illness nearing the end of life make decisions such as whether they want life-sustaining treatments on a mechanical breathing machine.

 

 

A new study led by a Johns Hopkins researcher suggests that hearing loss may be a risk factor for falls. The finding could help researchers develop new ways to prevent falls, especially in the elderly, and the resulting injuries, which generate billions in health care costs in the United States each year (Archives of Internal Medicine, 172: 369-71).  To determine whether hearing loss and falling were connected, Frank Lin, MD, PhD, of Johns Hopkins, and Luigi Ferrucci, MD, PhD, of the National Institute on Aging, used data from the 2001 to 2004 cycles of the National Health and Nutrition Examination Survey, which periodically has gathered health data from thousands of Americans since 1971.

The study found that people with a mild hearing loss (25 dB) were nearly three times more likely to have a history of falling. Every additional 10 dB of hearing loss increased the chances of falling by 1.4.  Even excluding participants with moderate to severe hearing loss from the analysis didn’t change the results.  This finding held true even when researchers accounted for other factors linked with falling, including age, gender, race, cardiovascular disease and vestibular function.

 

A $5,800 daily fine has been imposed against Bristol Nursing Home in Tennessee.  New admissions were suspended for a couple of days but for some reason was reinstated.  The state also imposed a one-time $3,000 fine.   The federal fine of $5,800 was to be imposed until violations discovered in March have been corrected.  The Tennessee Department of Health suspended admissions effective April 13 but it only lasted 4 days. 

A complaint investigation and annual survey conducted at the licensed 120-bed facility between March 26 and March 31 revealed serious  violations in the areas of, "administration, performance improvement, nursing services and resident rights."

At the center of the substantiated complaint is a mentally impaired and vulnerable male patient who fights with other men and has been accused of sexually assaulting female patients.  The staff complained that it was difficult to supervise him because of inadequate staffing.  He was admitted to the nursing home Aug. 9, 2011, and became violent and more focused on female patients after his ex-wife died sometime in November 2011. At times, he mistook several of the female patients as his ex-wife and complained that she was running around with some male patients.

The report cited:

Two violent men who have punched, pushed and kicked at patients;
Failure to draft a plan of intervention or increased supervision for the two violent patients;
A lack of incident reports, investigations or interventions related to incidents involving the most violent man;
Failure to notify a patient’s doctor of elevated blood sugar and need for psychiatric help
“The facility’s failure placed all the residents on the … unit in an environment which was detrimental to their health, safety, and welfare,” the report states.

 

The Washington Post reported that personal information was stolen from more than 228,000 Medicaid patients in South Carolina. Anthony Keck, the state’s Health and Human Services director, disclosed that information such as Medicaid ID numbers, names and addresses were taken by an employee.  Christopher Lykes Jr. was arrested.  Keck says he was fired last week but still hasn’t told authorities what he planned to do with the information from more than 228,000 people.  Lykes compiled the data over several months and then sent it to his private email account.