Syracuse.com had two articles (here and here) about James Square Nursing and Rehabilitation Center.  In 2015,  two out-of-state nursing home operators cut jobs at the 440-bed facility to save money.  A recent inspection found there were so few certified nurse aides some residents had to eat meals in bed and could not get up until late in the day.  A shortage of nurses and aides led to medication errors, delays in people getting showers and incontinence care, a woman falling out of a wheelchair and fracturing her shoulder and many other problems, according to the inspection.

In the unusual raid, armed investigators from the AG’s office seized records from the nursing home.  The inspection report said fewer nurses and aides were working in January than James Square’s staffing schedules showed. The inspection found discrepancies between those schedules and documented time clock and time sheet records.

Four families have filed lawsuits claiming a loved one died because of poor care and neglect.  The lawsuits claim James Square administrators failed to adequately staff the facility with qualified people, and failed to promote quality of care to the residents. A large number of wrongful death claims could be an indicator of patient care problems, according to a nursing home expert.

Richard Mollot, executive director of the Long Term Community Care Coalition, called the number of wrongful death claims at James Square “extremely troubling.”

“People very rarely sue when there is nursing home neglect or abuse, even when it leads to the death of the resident,” Mollot said.”If a facility has been sued by several different families it indicates, to me, that there is a risk that poor care may be persistent or widespread, or both.”

Medical organizations and other interest groups are weighing in on the Senate Republican health care bill, and they have major problems with the proposal.

The American Academy of Pediatrics says the bill would hurt children by scaling back Medicaid.

America’s Essential Hospitals says TrumpCare will lead to hospitals reducing services or closing.

The Association of American Medical Colleges says it would leave millions of people without health coverage.

AARP agrees with that assessment and is calling on every senator to vote no. AARP Executive Vice President Nancy LeaMond said in a statement Thursday that the bill would hit millions of Americans with higher costs and result in less health coverage. The bill would allow insurers to charge older adults up to five times as much as younger adults. LeaMond says AARP, which represents some 38 million Americans age 50 and older, is “adamantly opposed to the Age Tax.”

The American Medical Association strongly opposes limits on Medicaid spending. American Medical Association President Dr. David Barbe (Barb) said Thursday the group has a “grave concern with a formula that will not cover needed care for vulnerable patients.”

And the National Center on Addiction and Substance Abuse says the proposal will crush efforts to ending the opioid addiction epidemic. Joseph J. Plumeri of the National Center on Addiction and Substance Abuse says the proposed cuts to Medicaid mean fewer people will receive treatment for addiction. He says anyone who supports the legislation “cannot claim to be committed to ending the opioid epidemic.”

 The trade association for Catholic hospitals and nursing homes says it strongly opposes the Senate Republican health care bill, warning it would have a “devastating impact” on the poor and frail.

Sister Carol Keehan, president of the Catholic Health Association, says Congress should start over with a bipartisan approach. Keehan says, “The small tweaks made in the newly released Senate bill do not change the fact that millions will lose their health care, especially through a complete restructuring and deep federal funding reduction to the Medicaid program.”

Business Insider had an article explaining how nursing home residents are reliant on Medicaid.  The Medicaid cuts in TrumpCare will hit one unexpected group of people: elderly people living in nursing homes.

  • Medicaid covers health care expenses of 74 million low-income Americans, including nursing home care for those who can’t afford it.
  • Medicare, a program that covers medical expenses for Americans over 65 does not cover nursing homes.
  • The New York Times reports that 42% of Medicaid spending goes to services like nursing home care. Cutting spending in the program would hit the elderly, or put pressure on nursing home operators to cut back. The New York Times detailed the impact of Medicaid cuts on nursing home care in a story, and reports that — even though they only make up 6% of all Medicaid enrollees — those who use long-term services like nursing homes account for about 42% of total Medicaid spending. 

WJHL reported that Tennessee took a look at a Medicaid cost report for the Erwin Health Care Center because a recent audit raised serious questions about the nursing home’s handling of funds back in 2012.  According to the report, 27 nursing home residents on Medicaid were “inappropriately” charged to their trust fund accounts for diapers — a Medicaid-covered item.  According to the “Medicaid Bulletin, “diaper’s cloth and/or disposable, is a nursing facility responsibility and considered a covered service.”  The publication also says, “For covered items, the nursing facility may charge no more than the difference between the cost of an item and/or service it provides and one specifically requested by the named resident.”

The state auditor says “as of May 23, 2017, management has provided canceled checks as evidence that $560.16 has been refunded to residents or their authorized representatives. The remaining $2,108.72 has yet to clear the bank.”

In addition, the audit pointed out the nursing home improperly managed credit balances and failed to deposit residents’ funds into an interest-bearing account.

Ed Kilgore for New York Magazine had an article explaining how TrumpCare’s “mean” cuts to Medicaid will affect health care spending.

According to the Congressional Budget Office, TrumpCare will cut Medicaid spending $834 billion over ten years. The federal share of costs would be “capped” at a particular level per enrollee, with a fixed annual “growth rate” (basically the medical inflation rate).  The per capita cap reflects a long-standing GOP goal of ending Medicaid’s original status as an open-ended entitlement program in which the federal government would contribute a specified percentage of the costs incurred by states in covering eligible enrollees.

TrumpCare will also cut the Affordable Care Act’s federal subsidies for states (31 at this point) that choose to expand Medicaid eligibility to the universe of people (including able-bodied adults without children) with incomes under 138 percent of the federal poverty line.

‘Under ACA, the federal government initially covered 100 percent of the costs of covering the expansion population, a “super-match” that this year began declining toward a permanent level of 90 percent, still far above the usual match rate (which varies from state to state based on demographics, ranging from a minimum of 50 percent up into the 70s for a few really poor states). The House-passed AHCA would drop the super-match for new enrollees after 2020 (previous “expansion” enrollees would continue to receive the super-match so long as they had continuous coverage; in reality most would not meet that condition).”

The Senate version of the American Health Care Act institutes deeper Medicaid cuts than the House bill to help pay the cost of its expensive tax credits. The House version holds the program to the inflation rate plus one percent — which is historically lower than medical costs have risen, meaning that the program would have to curtail benefits for its beneficiaries, who tend to be poor and very sick. The Senate bill would cut growth down to the inflation rate, without the extra one percent.

The most important design feature is that the Senate bill retains all the tax cuts in the House bill. By eliminating nearly a trillion dollars in revenue, it necessarily creates a trillion dollars in cuts for coverage subsidies.

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The Madison-St. Clair Record reported the lawsuit filed against Integrity Healthcare of Alton; General Medicine, PC or in the alternative General Medicine of Illinois Physicians, PC; Senior  Healthcare Management, LLC; and Steve Blisco, alleging the defendants violated the Nursing Home Refort Act of 1987.

Jerome Bates, as administrator of the estate of Judith Bates, filed a complaint alleging neglect and failure to properly care for the decedent. On June 24, 2015, Judith Bates was a resident at the defendant’s nursing home and developed a urinary tract infection.  Judith Bates was also dehydrated, suffered from protein calorie malnutrition, had lost weight, suffered from urinary incontinence, could no longer eat and complained of abdominal pain. However, the plaintiff alleges no doctor was notified of her condition. The next day, Judith Bates died.

The plaintiff alleges the defendants failed to formulate and update a plan of care regarding hydration, weight loss, nutrition and diet, urinary incontinence and urinary tract infections and failed to provide appropriate hygiene and preventative measures to prevent recurrent urinary tract infections.

New York Magazine had an article about GOP moderates worried about TrumpCare’s health care cuts affecting the opiod crisis.  “During the worst year of the HIV/AIDS crisis, 43,000 Americans lost their lives to the virus. In 2015, 52,000 died of a drug overdose. Never in recorded history had opioids killed so many Americans in a single year; the drug-induced death toll was so staggering, it helped reduce life expectancy in the United States for the first time since 1993.”

The Medicaid cuts in TrumpCare will devastate addiction resources.  Medicaid expansion accounted for 61 percent of total Medicaid spending on substance abuse treatment in Kentucky, 47 percent in West Virginia, 56 percent in Michigan, 59 percent in Maryland, and 31 percent in Rhode Island. In Ohio, the expansion accounted for 43 percent of Medicaid spending in 2016 on behavioral health, a category that includes mental health and substance abuse.

As the New York Times reports:

Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act.

But that, too, is running into opposition from conservatives. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine.

Without some opioid funding, Mr. Portman cannot vote for the bill, he said, adding, “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”

Contagion Live had a discussion with Nicola Thompson, PhD, epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention who shared what is needed to estimate the burden of healthcare-associated infections in nursing homes.

Interview Transcript (slightly modified for readability):  “There has been a lot of work outside of the United States, in Europe, and also recently in the United States by the Centers for Disease Control and Prevention (CDC) to look at the prevalence of healthcare-associated infections in acute care hospitals. That data that has been collected has been used to translate the prevalence of infection into the burden over the course of the year. That has been done by a long-standing formula that has been out and has been published and used many times. That formula includes in it information on the average length of stay [for a patient].

Essentially the model that is used to estimate the burden of healthcare-associated infections from the prevalence takes into account the average length of hospital stay for people with a healthcare-associated infection, compared [with] the average length of hospital stay for people without a healthcare-associated infection. Those are the pieces for the inputs for the model. The differences between lengths of stay is used to estimate the national burden [of disease].

The concept of ‘length of stay’ does not really hold up when we think about the nursing home setting because the vast majority of people that are in a nursing home go there long-term to receive care and they are not anticipating a discharge. [Therefore,] we need to come up with a different approach to estimating the burden of [healthcare-associated] infections in nursing homes that does not rely on information, or take into account information on length of stay. That is really where the work that has been done by the European CDC (ECDC) to look at the burden estimation in nursing homes has been helpful to us.”