The Buffalo News reported that Ruthie’s Law became law.  The new law requires that all nursing homes in Erie County contact designated loved ones within two hours and provide “all known information” if a resident suffers serious injuries requiring outside treatment.  Ruthie’s Law also requires nursing homes to give prospective nursing home patients and their families a copy of the nursing home’s performance rating and to provide a summary of incident reports to the county’s Department of Senior Services twice a year.

This law was a result of the assault and injuries sustained by Ruth Murray.  Ruth was found by her family with deep purple bruises blooming all over her mother’s body, gashes across her temple and nose, and blood trickling down her neck.

Ruth suffered from dementia and had a known history of wandering including into another nursing home resident’s room. That resident, apparently thinking Murray was an intruder, beat her so severely that she ended up at Erie County Medical Center in critical condition with broken bones and a collapsed lung.

The graphic photos Kuszniaj took showed her mother black, blue and bloody. Her neck, nose and jaw were broken. So were 11 of her ribs and the bones on the right side of her face. Her lung had collapsed and had to be reinflated twice.  Three days later, her mother died.


The Bustle reported how Republicans are profiting from the repeal of ObamaCare  by buying up health care industry stocks as the bill moved through the legislative process.

According to the Intercept story, Representative Conaway, (R-TX), who is part of the House Republican leadership staff, bought up to $30,000 of United Health stock on March 24, the same day that the House version of the health care bill advance through a committee, while Senator James Inhofe (R-OK) bought between $50,000 and $100,000 of stock in the same company. The stock price of United Health has risen by 7 percent since March 24.

This isn’t the first time there have been problems of conflict of interest in lawmakers buying stocks. Tom Price, the Secretary of Health and Human Services, landed in hot water during his confirmation for the cabinet position due to purchases of pharmaceutical stocks at discounted prices while he was regulating the pharmaceutical industry. In 2012, Congress passed the STOCK act, which was aimed at preventing insider trading by members of Congress, after government officials had used top-level information to benefit themselves financially during the financial crisis.


The New York Times had an article about “Special Focus Facilities”.  Special Focus Facilities are the worse of the worse nursing homes.  “Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The Centers for Medicare and Medicaid Services, or C.M.S., assign each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.”

Designation requires the facility to immediately fix violations in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive.

“While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to an analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.”

Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement.  Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties. Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, the analysis found.

More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts. This year, the $2.6 million budget allows only 88 nursing homes to receive the designation, though regulators identified 435 as warranting scrutiny.  Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, the analysis shows.

Vanity Fair had an interesting article about Republicans’ talking point that Trumpcare will allow people the freedom to choose to be uninsured.  Senate Republican majority whip John Cornyn tweeted a Wall Street Journal opinion piece with the dubious title “How Many Jobs Does Obamacare Kill?” [Not many if at all]

Emily Singer highlighted the senator’s tweet and added, “Apparently to Cornyn, he views 22 million people losing health care as a fair trade for maybe 250K jobs.”

Cornyn’s response: “Not lose, choose. Apparently you believe freedom is optional.”

“If you’re not going to force people to buy something they don’t want, then they won’t buy it,” House Speaker Paul Ryan told Fox News. “So it’s not that people are getting pushed off a plan. It’s that people will choose not to buy something they don’t like or want.”

Wyoming Senator John Barrasso stated that uninsured individuals “were not actually losing insurance…because it’s a free country, they would choose, because we eliminate the individual mandate, to not buy insurance.”

This disingenuous talking point among defenders of the Better Care Reconciliation Act is false. The Congressional Budget Office’s assessment of the Senate Republicans’ bill reveals in the report: “few low-income people would purchase any plan” because they can’t afford to, especially given the expectation that premiums on reasonably high-quality insurance (so-called “silver plans”) are likely to increase for all Americans under the Republican plan.

A New Jersey state appellate panel determined that a trial court judge improperly failed to ask open-ended questions during jury selection in a suit by a deceased patient’s wife against a nursing home, throwing out a verdict in favor of the nursing home and reopening the case. The case is Estate of Joseph Gamma et al. v. Cedar Hill Health Care Center et al., case number A-3544-13T4 in the Superior Court of New Jersey, Appellate Division.

The court did agree with Gamma that the trial court judge should have asked at least three open-ended questions during jury selection, as required by New Jersey law.
“The questions [posed to the jury] did not elicit verbalized open-ended responses from each juror, and we cannot confidently conclude that the jury empanelled was both fair and impartial,” the per curiam decision said.

Gamma sued Cedar Hill and several of its staff following the death of her husband, Joseph Gamma, in April 2009. Gamma alleged that Cedar Hill failed to provide rails on its bed, which allowed her husband to fall out of bed, causing injuries that later led to his death.

Gamma sued for negligence and violations of the New Jersey Nursing Home Responsibilities and Residents’ Rights Act. The judge directed a verdict on the question of the Residents’ Rights Act, and the jury found in favor of Cedar Hill concerning negligence.

On appeal, the panel ruled that the trial court had not abused its discretion by directing a verdict, but agreed that the court had erred during jury selection. The panel noted that the trial judge had asked jurors standard biographical and omnibus questions but failed to also ask open-ended questions required by Administrative Directive #4-07.  The judge also rejected a request from the attorneys to ask open-ended questions, according to the decision.

Stat News reported that TrumpCare may cut a national initiative to help patients leave nursing homes and regain their independence — which has saved taxpayers hundreds of millions of dollars.  The Money Follows the Person program, which uses both federal and state Medicaid dollars, helps patients who are leaving nursing homes buy their own furniture and pay the security deposit on an apartment. It even covers an initial trip to the grocery store.

Launched in 2007, the Money Follows the Person initiative has distributed $4 billion over the past decade to help agencies in 43 states and D.C. test alternatives to institutionalization. Federal grants cover all home- and community-based services for the first year following a patient’s transition. Then state Medicaid funding takes over.

Even if a patient needs regular visits from health aides, the cost is often far less than a nursing home would charge.  A report published this spring by Mathematica Policy Research, which has a federal contract to evaluate the program, found it saved taxpayers $978 million in just its first six years, through 2013. Through the end of 2015, the program had moved more than 63,000 longtime nursing home residents into independent living.

The grants also cover visits from home health aides so patients with ongoing medical needs can get care. And they support life skills training which teaches students to use public computers to look for jobs and helps them set up email accounts, in some cases for the first time in their lives.

It’s exactly that kind of home-based care that could be first in line for cuts if the Republican plans pass, policy analysts say.  States are required to cover nursing home care through Medicaid, but services to help patients transition to independent living are optional. Advocates for independent living say that such cuts could cause real harm to people with disabilities.

“If Medicaid is cut or capped, we know that home- and community-based services will be the first to go, and that will leave many, many people with disabilities unable to live in the community. It will force us back into nursing homes,” said Cara Liebowitz, who was among of group of advocates at a recent protest outside Senate Majority Leader Mitch McConnell’s office.



One of the fastest-growing fields is direct care: There are at least 3.6 million direct care workers in the US, not including an estimated 800,000 unreported workers, according to researchers.  Vox had an article explaining the difficulty for caregivers to make a living wage.  “In interviews, home care aides told Vox about the drawbacks of a booming field: aching backs, unstable schedules, second jobs, salaries low enough to qualify for Medicaid, and emotional burnout. Health care jobs might be a beacon of the new economy. But that doesn’t mean they’re good news for the workers who do them.”

Most new health care jobs are low-paid

“Many direct care workers — home health aides, nursing assistants, and direct support professionals like Rowe — struggle to make ends meet. Despite the physical and social skills required, direct care workers are some of the lowest-paid workers in the nation, on par with fast-food workers. Rowe now makes $13.40 an hour — about half as much as he could be making as a mechanic — in a state where the median hourly wage is $18.”

“An estimated 46 percent of home care workers depend on Medicaid for their health coverage. Medicaid is also the largest payer of home and nursing care services, which means the poor are essentially taking care of the poor.”

Health care jobs projected to increase, while production to decline

FiveThirtyEight has TrumpBeat, a weekly feature on the latest policy developments in Washington and beyond.  President Trump and other Republicans have said repeatedly that they have to repeal and replace the Affordable Care Act is that the law is failing: Healthy people are abandoning the insurance marketplaces set up by the law, driving up costs and leading yet more people to drop insurance — a so-called “death spiral.” Many health insurance experts, however, have argued that those fears are overblown, and they recently got support from an unlikely source: the Trump administration itself.

The Centers for Medicare and Medicaid Services, which is part of the Department of Health and Human Services, released a report about a wonky aspect of the Affordable Care Act related to insurance payments. Tucked away in the report, however, was evidence that the health insurance marketplaces set up by Obamacare were relatively stable in 2016. Contrary to the “death-spiral” narrative, the CMS report found that the mix of healthy and sick people buying insurance on the Obamacare marketplaces in 2016 was surprisingly similar to those who enrolled in 2015.

The report looked, in part, at so-called risk-adjustment payments, which are part of the ACA’s system for encouraging insurers to enroll high-cost patients. This system is meant to prevent insurers from cherry-picking the healthiest people on the market by collecting money from plans with healthier enrollees to distribute to plans that have people with higher health care costs.

To determine the mix of healthy and sick enrollees for risk-adjustment payments, the federal government assigns risk scores to people based on their age, sex and health diagnosis and then averages the scores for a plan. What CMS found was that those averages were relatively stable in 2016. Despite expectations that in the face of rising premiums, healthier enrollees would be less inclined to enroll last year, that doesn’t appear to have been the case.

Kindred’s recent press release stated that Kindred Healthcare, Inc. (“Kindred” or the “Company”) (NYSE:KND) has signed a definitive agreement with BM Eagle Holdings, LLC, a joint venture led by affiliates of BlueMountain Capital Management, LLC (“BlueMountain”), under which it will sell the Company’s skilled nursing facility business for $700 million in cash. The sale includes 89 nursing centers with 11,308 licensed beds and seven assisted living facilities with 380 licensed beds, which collectively have approximately 11,500 employees in 18 states.

As previously disclosed, 36 of the skilled nursing facilities (the “Ventas Properties”) are currently leased from Ventas, Inc. (“Ventas”) (NYSE:VTR), and Kindred has an option to acquire the real estate of the Ventas Properties for aggregate consideration of $700 million. As Kindred closes on the sale of the Ventas Properties to BlueMountain, Kindred will pay to Ventas the allocable portion of the $700 million purchase price for the Ventas Properties and Ventas will convey the real estate for the applicable Ventas Property to BlueMountain or its designee.

Kindred expects to realize net value of approximately $210 million, subject to post-closing adjustments, and after the $700 million payment to Ventas, estimated transaction costs of approximately $35 million and estimated severance costs of approximately $35 million.

Discontinued Operations Accounting Commentary

The Company anticipates that substantially all of its skilled nursing facility business, and the contribution margin from applicable RehabCare contracts servicing the Company’s skilled nursing facility business, will move to discontinued operations when reporting second quarter results in August, at which time the Company intends to provide updated guidance and adjust prior periods to reflect the anticipated sale. The Company estimates this accounting change will reduce second quarter reported core earnings before interest, income taxes, depreciation, amortization and rent (“EBITDAR”) from continuing operations by approximately $35 million(2)(3) and have a roughly breakeven(2) impact on second quarter core diluted earnings per share.

The Company notes these amounts assume that no RehabCare contracts servicing the Company’s skilled nursing facility business are retained. Discontinued operations accounting rules do not allow the associated contribution margins from these contracts to be reported as continuing operations unless contracts for those facilities are signed with the new operators. The Company historically has retained approximately half of such contracts in similar divestitures and anticipates similar contract retention levels for this transaction. The Company expects this will result in approximately $10 million(2) of incremental annual core EBITDAR performance (approximately $2.5 million(2) per quarter) in continuing operations upon execution of contracts with new operators.

The Company further notes that, due to the requirements of discontinued operations accounting, these figures do not include the benefit of approximately $20 million to $25 million of additional annual cost reductions (approximately $5 million to $6 million per quarter) enabled by this transaction that the Company expects to achieve, and are included as part of the $70 million to $80 million of anticipated cost reductions indicated above.

About Kindred Healthcare

Kindred Healthcare, Inc., a top-90 private employer in the United States, is a FORTUNE 500 healthcare services company based in Louisville, Kentucky with annual revenues of approximately $7.2 billion(4). At March 31, 2017, Kindred through its subsidiaries had approximately 100,100 employees providing healthcare services in 2,624 locations in 46 states, including 82 long-term acute care hospitals, 19 inpatient rehabilitation hospitals, 91 nursing centers, 19 sub-acute units, 619 Kindred at Home home health, hospice and non-medical home care sites of service, 101 inpatient rehabilitation units (hospital-based) and contract rehabilitation service businesses which served 1,693 non-affiliated sites of service.

New York Magazine had an article about Paul Ryan’s defense of TrumpCare. Here is Paul Ryan explaining why the Congressional Budget Office’s finding, that the Senate bill increases the uninsured population by 22 million, does not really take anything away from anybody.  Rather, eliminating the individual mandate will free them from having to buy something they hate: “It’s not that people are getting pushed off a plan, it’s that they will choose not to buy something they don’t like or want.”

Of course, that is patently false.  CBO concludes that two-thirds of the people who will lose coverage will do so because of cuts to Medicaid. The Senate plans to slash the Medicaid budget by about one-third by the tenth year.

The individual market would also shrink because Republicans would cut funding for people who buy plans, rendering coverage unaffordable for millions. CBO explained that the working poor won’t be able to buy insurance because the premiums and deductibles will be too high.