In a report by NPR, some of the basic questions about the Affordable Care Act are answered. The ACA will begin on Jan. 1, 2014, with people able to sign up for the program on Oct. 1. NPR readers and listeners sent in questions they had about the Act, which NPR answered. More questions can be sent in to: morningedition@npr.org.

Here’s the basic breakdown of those answers:

• People in the individual insurance market can participate in the ACA. If you don’t have health insurance from an employer, you’re self-employed, or you don’t qualify for Medicare benefits and you don’t have a job, you can buy health insurance through the exchange.

• People can get some type of assistance with their premiums if they are in the $11,490 – $45,690 income range. If you have to spend more than 8% of your income on health insurance, you don’t have to buy it, and you won’t be paying a penalty. There are also other exemptions from the rule if you can’t afford the coverage.

• Premiums seem to be averaging between $200 – $400 for the ‘silver plan’.
• Those with employer coverage and government coverage will not have to purchase additional coverage.

• Those who have or are offered coverage through an employer aren’t allowed to participate in the exchange. If they do go to the exchange, they won’t receive any assistance with their premiums. However, there are exceptions to mandated employer coverage.

• Preexisting conditions will not cause you to have a higher premium.

• Certain religious groups, like the Amish and Mennonite sects, don’t pay into Social Security. Because of this, they will be exempt from mandated coverage.

• Anyone who lives outside the US for at least 330 days in a year will be exempted from the requirement to have coverage.
 

Maureen Flowers, a nursing home worker in NY faces charges of manslaughter and criminally negligent homicide in the death of Sinia Malone, 86. Her son, Rev. Lee Thompson, is advocating for more oversight in homes as a result of his mother’s death. Flowers attempted to lift Sinia without assistance from another staff person. She dropped Sinia, whereupon she left her bleeding and in need of assistance so she could go convince another staff person to lie about what happened. Sinia Malone died in February 2012 as a result of the incident.  See AP article here.

Rebecca Mead wrote a great article in the New Yorker called "The Sense of an Ending" about the best ways of responding to people suffering with dementia.  Mead’s article details nursing home care that should be the standard for every and any facility or any person that works with elderly people, whether they be in Nursing Homes, Assisted Living Facilities, or Dementia Care but that is simply not the case.  The quality of care that Mead describes is not the standard that facilities meet.

Currently, we place the frailest and weakest of those in our society in the hands of understaffed, overworked, and poorly trained people.  And then we allow lax enforcement.  For the quality of Nursing Homes to equal the care described at Mead’s facility, there will have to be more rigorous standards and enforcement of those standards. Otherwise, we can look, perhaps not forward to, but certainly at the inevitability of a continued broken system which results in elder abuse and neglect on a national scale.

 

Nursing homes with a large minority presence perform more poorly than those with a small minority presence, a new report finds. The finances and quality of minority nursing homes falls below that of non-minority nursing homes. Nursing homes may admit residents based on their skin color, selectively admitting residents based on race and payer status-whether Medicare pays or a private party. As minorities rise in future years, this issue could become increasingly important, with the civil rights of much of the population placed into jeopardy because of nursing homes’ racial disparity. The full article and report can be found here.

President Obama’s 2010 memorandum on same-sex partner visitation does apply to nursing homes and other long term care facilities, the Centers for Medicare & Medicaid said. Residents have the right to visitors on a 24 hour basis, which includes family members, friends, and spouses or partners. The memorandum previously included hospitals and other medical facilities, but there was some confusion over whether it applied to LTC facilities or not.  See article at Washington Blade.

A Minneapolis resident went into cardiac arrest after Fairview University Transitional Services failed to administer the anti-coagulant the resident needed. As a result, he died from blood clots in his lung. The resident was not getting heparin because the staff failed to communicate and thought others administered the medication. The facility did not have adequate policies and procedures in place to assist in reviewing medical information. This is outrageous and was clearly preventable.

See article at Star Tribune.

In a Georgia Alzheimer’s care facility, Alzheimer’s Care of Commerce, more than 20 employees are facing charges of abuse, neglect, and financial exploitation. The facility’s administrator Donna Wright is one of the alleged perpetrators. An investigation occurred after there were multiple complaints of abuse and neglect about the home. The facility engaged in numerous illegal practices, including employing convicted felons, improper medication administration, and subjecting residents to inhumane practices and degrading conditions. The staff used ‘double diapering’ wherein two diapers are placed on the patient so the staff doesn’t have to change soiled diapers as much. This practice is extremely humiliating and unsanitary. The current and former employees are faced with over 70 charges. See article at McKnight’s.

It’s often difficult to understand who owns nursing homes. Piercing the corporate veil, as it’s come to be known to plaintiff attorneys is a daunting task. Many homes have been ‘converted into real estate investment trusts, or REIT[s], … under names like Venta, Senior Housing Properties Trust, and … Health Care REIT.” These groups, which are large real estate conglomerates, are seeing an increase in profits, even though Medicare cuts in 2011 meant cutting expenses, which was expected to eat into profits. Though the groups are profitable, many health care companies don’t want to be associated with the groups, in fear that additional cuts to Medicare will result in real and deep cuts to profits. The business of caring for the elderly may be profitable now, but with Medicare cuts happening more and more, even the minimum safety and adherence to regulations may be in danger of disappearing altogether.

See article from The Street.

In a new analysis of nursing homes, it’s been alleged that the quality of nursing home care and staffing has actually increased between 2009 and 2011, with most of their star ratings from CMS improving. Some homes saw a lower rating.  The number of one-star ratings has decreased and the number of four and five-star ratings increased. Star ratings are based on iinformation provided by the facility on health inspections, staffing, and quality measures.  Quality scores fluctuated the most within the 3 year study, and staffing scores maintained the most consistency. Check out the complete report with nursing statistics and more information here. This study is only as reliable as the information provided by the facilities.  They have figured out ways to manipulate the numbers and cover up incidents so their ratings increase.

See article at McKnight’s.