This video is from a talk from Joe Steier, the CEO of Signature Healthcare.  In 1999, Mr. Steier joined Home Quality Management, now Signature HealthCARE LLC, as President to help grow the organization into a regional long-term healthcare provider.  He thinks the demand for "the Western model" of running nursing homes (read "for profit and cutting corners" is big overseas and many large chains and his company will be overseas soon.  What a surprise, he thinks the regulations in the US are somehow punitive.  He complains about the government cracking down on fraud and abuse.  He thinks the industry needs more protections against lawsuits for neglect and abuse.

Meanwhile, MarketWatch reported that publicly traded companies that operate facilities in multiple states show "record revenues" and "operating profits that exceeded expectations."  One company’s revenues spiked 62% over the same quarter last year while another company squeezed out an additional $2.26 per resident day over fourth quarter 2011 Medicare rates.  And high profitability shows no signs of slowing. Recent nursing home sales show price per bed costs (a financial solvency benchmark) are quickly rebounding after last year’s fall off, skyrocketing to as much as $95,000 per bed.

"Strong margin calls may appease shareholders and investors, but many residents are languishing from pressure sores, broken bones and the overuse of antipsychotic medications," Brian Lee of Families for Better Care said. "Facing a 1 in 3 chance of being admitted into a lousy facility is a daunting proposition for consumers."

"There is a way to balance profitability and quality of care and that is through greater transparency and disclosure from nursing home companies and their affiliates. This will allow payment systems to be restructured, guaranteeing taxpayer dollars go directly to resident care and safety," Lee commented.

 See below for Summary of publicly traded nursing home’s first quarter reports

 

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Many Americans who have experienced a serious illness or injury within the past year are concerned about the financial costs of medical care, and the quality of and access to that care, according to a new poll out today from NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. Results of the poll, one of the first of its kind, reveal that three out of four sick Americans say that cost is a very serious problem, and half label quality of care as very serious problem. 

These findings provide the basis for NPR’s “Sick in America,” a series looking at the serious issues facing the ill in this country, beginning today and airing all week on Morning Edition and All Things Considered. In the series, NPR correspondents from around the country take measure of what it’s like to be sick in America, from deteriorating insurance coverage, to an increasingly fragmented health system, to a nursing shortage and the quality of hospital care.

 The poll surveyed both the general public and those with a serious illness, medical condition, injury or disability. It was conducted by researchers at the Harvard School of Public Health. Complete results are at NPR.org, where all reports in the series will be available. Among the key findings:

 · A large majority of the general public (87%) thinks the cost of care is a serious problem for the country. In addition, about two-thirds of the general public (65%) believes the cost of care has gotten worse over the last five years.

 · More than 40 percent of sick American say that the cost of their medical care over the last 12 months has caused a “very serious” (20%) or “somewhat serious” (23%) problem for their or their family’s finances.

 · High costs affected access to care. One in six sick Americans say that there was a time in the past 12 months when they could not get the medical care they needed. Of that group, 52% report that it was because they could not afford the needed care, and 24% say it was because their insurers would not pay for it.

 · Interestingly, 78 percent of both the recently sick and the non-sick said that not being able to afford the tests or drugs they need was a major reason for the problems in quality of care.

 · Half of those who’ve been hospitalized overnight during the past 12 months (51%) said they were very satisfied with the quality of care they received.

 “Sick in America” is being reported by NPR’s Science Desk, with NPR correspondents Richard Knox, Patti Neighmond, Julie Rovner and Rob Stein, and reporter Sarah Varney of member station KQED.

 The poll is part of an ongoing series of surveys on health conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

 

The Atlantic had an interesting article about the mitigating effects that feelings of a life purpose can have on slowing the progression of Alzheimer’s disease.  An ongoing study since 1997 has shown that an individual’s sense of life purpose can lessen the risk of later cognitive impairment.  In the study participants are asked to rate how well they relate to statements such as “I feel good about what I have done in the past and I feel hopeful about what I will do in the future” or “I used to set goals for myself but now that feels like a waste of time.” When the participants die their brains are autopsied to determine the amount of plaque accumulation in the pathways of the brain caused by Alzheimer’s.

The autopsies have shown that there is no physical difference between the brains of those individuals that rated high life on purpose and those without it. These finding show the feelings of purpose do not prevent the actual buildup of detrimental materials in the brain.  However, the participants that had a strong feeling of life purpose did have an overall 30% lower risk of cognitive decline. This means that the strong beliefs that one has a reason in life gives an individual a higher level of what researchers call a “neural reserve.” This reserve does not prevent plaque build up or brain damage but gives the brain the ability to sustain damage and respond to it much more efficiently.

Overall the study found that engaging work and purposeful living improves brain health and mitigates the harmful cognitive effects of Alzheimer’s, “It would appear that humans are hard-wired a bit like working dogs — we may dream about a life of ease aboard luxury yachts, but we are at our best when we are gainfully engaged in meaningful work.”
 

NPR reported recently that patients complain about doctors not listening or being responsive to their issues.  A new poll by NPR, the Robert Wood Johnson Foundation and Harvard School of Public Health found about 3 out of 5 patients think their doctors are rushing through exams. That’s nearly the exact same number as three decades ago.  Doctors blame the rush on reimbursement rates explaining that the need to rush patients is based on the need to see many patients to make economically feasible to survive.

"There’s some data to suggest that the average patient gets to speak for between 12 and 15 seconds before the physician interrupts them," Dr. Larry Shore says. "And that makes you feel like the person is not listening."

 

 

As reported by The Sate an Orangeburg, South Carolina doctor accused of inappropriately groping a patient has been arrested. In early November of last year a patient was leaving Dr. Robert Major Jones’ examination room when Jones groped her behind. The patient asked him what he was doing and after pushing Jones off left the examination room. Jones is being held at the Allendale County Detention Center.

The State also reported that a national advocacy group declared South Carolina as worst in the nation at reprimanding physicians for ethical violations and other breaches of the standard of care.
South Carolina has been among the bottom 10 states at disciplining doctors for each of the past nine annual rankings by Public Citizen’s Health Research Group.  The study found South Carolina has taken serious disciplinary actions – defined as revocations, surrenders, suspensions or probations – against only 1.33 doctors per 1,000 annually in the past three years.

The national average is only 3.06 based on Public Citizen’s analysis of medical board data from all states and the District of Columbia. 

“There is considerable evidence that most boards are inadequately disciplining physicians,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “Action must be taken, legislatively and through public pressure on medical boards themselves, to increase the amount of discipline, and thus, the amount of patient protection.”
 

 

As reported in The Daily Beast, the price of United States health care is steadily increasing. However, the amount and quality of care in American is not increasing proportionally. 

Growth-in-Utilization

In one year alone the intensity of inpatient admissions increased a mere 0.7% while the intensity -adjusted price of health care increased a massive 4.6%. This is largely due to the health care system moving away from the public sphere an into the less productive, private sphere.

Key Findings from this Report

•Per capita health spending among people under 65 is growing moderately, up 3.3 percent from the previous year but still nearly three times the rate of general inflation.

•Higher spending was mostly due to price increases, rather than changes in the use of health care services: Prices for hospital admissions, outpatient care and prescription drugs all grew at a much faster rate than general inflation in 2010.

•Health care spending grew fastest among those who are 18 and younger.
 

Poltitico reported on a disturbing trend in the American health care system. The article explained that a new Commonwealth Fund study has found that out of 12 industrialized countries the United States ranks highest on money spent on health care. Norway and Switzerland are ranked 2nd and 3rd and only spent around $5,000 per citizen on health care in 2009, while the United States spent a whopping $8,000.

However, this rise in health care expenditures is not due to a greater number of doctor visits by citizens. U.S. citizens have an average of 4 consultations per year, putting them at the bottom for the number of doctor visits in comparison to other industrialized countries. Nor is the rising costs attributed to longer hospital stays. The same study found the U.S. to be ranked very low for length of hospital treatments. The study found costly medications and treatments attribute to the rising expenses. The high prevalence of obesity, a condition that greatly increases medical spending, is also thought to be possible cause.

Overall the study concluded that greater spending on health care does not necessarily correlate with an increased quality of health care, “The findings make clear that despite high costs, quality in the U.S. health care system is variable and not notably superior to the far less expensive systems in the other study countries,” Squires wrote.
 

The Hartford Courant reported on the tragic and preventable death of a nursing home resident. The death occurred at the Aurora Senior Living Center in Cromwell, Connecticut. The incident happened when a nurse improperly authorized a visitor to give the resident a marshmallow and she choked to death. The nurse failed to failed to check the resident’s diet restrictions and was not aware that the resident was on a ground-food only diet by doctors orders. The resident had dysphagia, or difficulty swallowing, and required intensive assistance while eating, including reminders to swallow. During the incident the resident became unresponsive and went into cardia arrest. She died two days later at a nearby hospital.

 

The Pittsburg Post-Gazette reported that a Machelle Looney, a staff member from Lynn’s Personal Care Home in Windgap, Pennsylvania has been charged with stealing her residents’ morphine pills.   Morphine is a narcotic used to treat serious pain.   How could anyone take someone else’s needed pain medication especially someone hired to take care of a resident?

She then left the residents that were in her care alone while she left the home in attempt to sell the stolen pills. Some of the residents that Looney was responsible for suffer from dementia and require constant supervision.
Looney is charged with drug possession, possession with intent to deliver, theft by unlawful taking and reckless endangerment.
 

An interesting article on RGJ explained that Omnicare, a drug provider to long-term facilities including nursing homes, will pay $50 million dollars to settle allegations that it has improperly provided nursing home residents with drugs without a doctor’s prescription since 2007.  U.S. Attorney Steven Dettelbach stressed the severalty of this when he explained, “ It was the second-largest monetary settlement nationally in the history of the Controlled Substance Act regarding drugs.”

Even when Omnicare properly had a prescription for the drugs, the company frequently failed to include the drug name, amount of the dosage, strength, or the quality.  Clearly the company was more interested in profits than the care and treatment provided to residents.  Omnicare is very profit driven in their actions since there is much money to be made in the high volume dispensation of medication. 

Dettelbach hopes that the settlement will send a message, “Doctors need to be involved in the key care decisions regarding patients involving providing these controlled substances.” In the past pharmacies in nursing homes have operated without a clearly defined set of regulations.  They act at their own discretion, frequently providing drugs on only the staff’s instruction and without a prescription. It is hopeful that this settlement will act as warning and create more clearly defined rules and regulations that must be followed when dispensing regulated substances.

The Justice Department complaints say, among other things, that Omnicare:

• Routinely dispensed narcotics and other controlled substances to residents of long-term facilities without prescriptions signed by doctors.

• Dispensed those controlled substances using prescriptions missing essential information including the name of the drug, dosage, strength, quantity, DEA number and other information.

• Did not properly document partially filled prescriptions, which prevented the DEA from conducting an audit.