Monthly Archives: September 2017

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“Many of America’s roughly 15,600 nursing homes are unprepared for disasters like Hurricane Irma, which recently killed 11 elderly patients in South Florida after the Rehabilitation Center at Hollywood Hills lost power.”  The Huffington Post had a great article explaining why the tragic disaster that occurred at a Florida nursing home can happen anyway.

The problem starts with inadequate staffing, an issue that plagues most of the industry. Roughly half of American nursing homes are understaffed compared to expert recommendations, and at least a quarter are considered “dangerously” low-staffed, according to a 2016 review of studies into the issue.

“Federal regulators have cited at least 2,300 facilities for violations of emergency preparedness regulations in the past two years alone, according to a Kaiser Health News review of federal records.”

“Efforts to improve the way nursing homes prepare for emergencies have at times run into opposition from an industry concerned with the cost of new regulations. Industry lobbyists, for instance, successfully derailed a 2006 Florida bill that could have forced nursing homes to have generators on-site. A 2015 federal proposal to increase staffing requirements died thanks to similar opposition.”

Nursing home industry lobbyist LeadingAge Florida is challenging Gov. Rick Scott’s order to install generators at the facilities after this most recent tragedy.

 

The Tampa Bay Times reported the omission of information in Florida’s investigations into nursing home abuse and neglect complaints. In the past year, Governor Scott’s Agency for Health Care Administration has purchased and employed new redaction software that removes key words, dates and descriptions from the inspection reports posted online and used by the public to monitor conditions at the 683 nursing homes and more than 3,100 assisted-living facilities in the state.

For family members that want information about what state regulators know about a nursing home, Governor Scott has increasingly made access to that information harder to get, said Brian Lee, the head of a national watchdog group called Families for Better Care.  “There’s no rhyme or reason to it,” Lee said. “They are so indiscernible now, they’re almost useless. If the feds can put this same information on its web site, why can’t the state? It’s a favor to the industry by the Scott administration.”

The Huffington Post had an interesting article about the loss of rural hospitals and their effect on the rural economy.  “Rural hospitals are in danger across the country, their closures both a symptom of economic trouble in small-town America and a catalyst for further decline.”

Since 2010, 82 rural hospitals have closed nationwide. As many as 700 more are at risk of closing within the next 10 years, according to Alan Morgan, the CEO of the National Rural Health Association, a nonprofit professional organization that lobbies on rural health issues.

The South also has the largest cluster of states that have not expanded Medicaid under the Affordable Care Act: Alabama, Florida, Georgia, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia.  Expanding Medicaid would have meant greater access to insurance for low-income people and more reimbursement for hospitals, thus helping their bottom lines.

Many baby boomers hit an important milestone last year. Those earliest boomers born at the start of 1946 turned 70and are now turning that age at a rate of 10,000 people per day for the next 18 years.  The Census Bureau also indicates that for the first time ihistory the aging populations of 65 and older will double that of children (ages 5 and under) worldwide within the next 3 years.  This has broad implications on health care and nursing, both now and well into the future, especially as there is already a shortage of nurses. 

As the nursing industry deals with this worrisome shortage, nursing schools are trying to meet the demand by expanding their programs and offering accelerated coursework; however, it is still projected that there will be a massive scarcity of Registered Nurses (RNs). 

According to the American Association of Colleges of Nursing (AACN), the demand for RNs in the workforce is expected to increase 16 percent to 3.2 million jobs in 2024, one of the highest of any industry in the U.S. Unfortunately; 1 million RNs will be reaching retirement age in the next 10 to 15 years. So, who will replace these retirees and make up for the anticipated demand? That’s not clear yet.  

The AACN reports nursing schools across the country have only seen a 3.6 percent increase in enrollment, nowhere near enough to meet the projected demand of nurses in the coming years. Compounding the problem is the lack of qualified faculty. The AACN reports 64,067 qualified nursing school applicants were turned away in 2016 due to a lack of faculty 

More details on the nursing shortage crisis, along with a helpful graphic can be found at www.nursingschoolhub.com/nursing-shortages 

As the latest Trumpcare proposal stalls in the Senate, Trump continues to sabotage the Affordable Care Act by announcing that healthcare.gov, the website Americans use to sign up for insurance through the marketplaces put in place by Obamacare, would be down for maintenance for 12 hours every Sunday in the middle of the upcoming open-enrollment period.

No explanation was given for the outages, but this “maintenance schedule” is a plan to keep down enrollment, and a reckless indifference to the needs of the population it is supposed to be serving.

Tom Price’s Health and Human Services Department has already announced massive cuts to the navigator programs that fund Obamacare outreach, as well as the budget for ads that alert Americans to the existence of the open-enrollment period.

The White House is currently paying out the cost-sharing reductions (or CSRs) on a month-to-month basis but has made no commitment that they will stay in place next year. Guaranteeing this funding would prevent an average 20% spike in premiums next year on the standard Obamacare “silver” plans, according to the Congressional Budget Office.

Close to 20% of nursing home assistants are living below the federal poverty line, a result of low wages and part-time positions, according to The Paraprofessional Healthcare Institute’s new report.

Nearly 40% rely on some form of public assistance.  Wages “barely kept up with inflation” over the past decade. The average hourly wage for a direct care worker was $12.34 in 2016, compared to $12.35 in 2006, the report found.  [It is much less in South Carolina].

Despite the profound support they offer to millions of older people and people with disabilities nationwide, direct care workers remain undervalued and poorly compensated,” PHI President Jodi M. Sturgeon said in a statement. “Our country needs to improve wages and hours, provide more training and career paths, and implement workforce innovations that transform this sector — improving care for all of us.”

The data predicts new nursing assistant jobs will make up 39% of total employment growth in the sector, adding to the more than 600,000 frontline positions currently held in the U.S.

Click here to read the full PHI report, which also includes data on workers’ insurance coverage, injury rates, education and demographics.

New York Magazine reported that the sweetheart deal (to bribe Senators from Alaska and Maine to support Trumpcare) may be unconstitutional.  The revised bill makes it even more obvious that Republicans are trying to sweeten the deal for particular lawmakers rather than attempting to craft a better bill.  According to a summary circulated by Republicans, key states with Senators that oppose Trumpcare will see spending increases between 2020 and 2026: Alaska (3 percent/Murkowski), Arizona (14 percent/McCain), Kentucky (4 percent/Paul), and Maine (43 percent/Collins).  Is it legal or ethical to bribe a Senator for their vote?

The latest Trumpcare proposal gives Alaska and Maine especially generous treatment including a complete exemption from the deep cuts to Medicaid and tax credits that other states will suffer.  Obamacare would be repealed in the other states, but suspiciously live on in states whose vote Trump needs really badly.

Georgetown law professor Brian Galle explains that the Constitution has a uniformity clause — Article I, section 8 of the Constitution says “all Duties, Imposts and Excises shall be uniform throughout the United States.” The purpose of the clause is to prevent coalitions of states from ganging up on others to impose discriminatory treatment.

The clause has not been tested before, but that is only because there are few cases in which the people running the government have passed a law so blatantly discriminatory.

The Press Democrat reported the lawsuit against Oakmont Senior Living chain founded by Sonoma County developer Bill Gallaher, accusing his company of fraudulent practices that allegedly deprived residents of needed care and exposed them to risk of injury.  Oakmont Senior Living, a privately held company based in Windsor and founded by Gallaher in 1997, operates 23 senior living facilities in California.

Fees at the facilities — which ran as high as $10,000 a month per resident — were based on “budgets driven primarily by desired profit margins” rather than assessments of its residents’ individual needs, the suit claimed.

The lawsuit alleges residents were found on the ground, left to sit in their own waste and at least one suffered an unexplained injury at the company’s assisted living facilities.  The Oakmont Senior Living facilities were understaffed and residents age 65 and older “run the continuing risk of not having their care needs met and of suffering frustration, pain, discomfort, humiliation and/or injury from inadequate care and supervision.”The lawsuit alleged that Oakmont violated the Consumer Legal Remedies Act, committed elder financial abuse and engaged in “unlawful, unfair and fraudulent” business practices.  The 43-page complaint did not specify the amount of financial damages it was seeking. If a judge certifies it as a class action case, the number of plaintiffs could expand to thousands and the potential penalties against Oakmont could be in millions of dollars, said Kathryn Stebner, a San Francisco attorney who filed the lawsuit with nine other attorneys.

The company “actively conceals from residents, prospective residents, and their family members the true facts about its corporate policy and practice of prioritizing profit over resident care,” it said.

 

 

Vox explained that only 24% of Americans approve of the latest Trumpcare proposal.

Among Public Policy Polling’s findings:

  • Approval of Obamacare remains high, with 54 now in support and 38 opposed.
  • 51 percent of Americans believe Graham-Cassidy would “scale back” protections for those with preexisting conditions. Only 27 percent believe people with preexisting conditions will keep their insurance.
  • 68 percent of Americans believe that Republicans should wait for the Congressional Budget Office to score the legislation before implementing it.
  • About half of Americans say they’re less likely to vote for a member of Congress who votes for Graham-Cassidy; 23 percent say voting yes would make them more likely to support that representative.

Politico article: “To date, not one major health care industry or advocacy group has expressed support for the Graham-Cassidy plan.”

And that includes insurance companies.

The health insurance industry, after cautiously watching Republican health care efforts for months, came out forcefully on Wednesday against the Senate’s latest bill to repeal the Affordable Care Act, suggesting that its state-by-state block grants could create health care chaos in the short term and a Balkanized, uncertain insurance market. […]

The two major trade groups for insurers, the Blue Cross Blue Shield Association and America’s Health Insurance Plans, announced their opposition on Wednesday to the Graham-Cassidy bill. They joined other groups fighting the bill, such as the American Medical Association, the American Hospital Association, AARP and the lobbying arm of the American Cancer Society.

A recent report the Center on Budget and Policy Priorities wagers that more than 32 million people could lose healthcare as a result of Graham-Cassidy, which could slash federal healthcare funding by nearly $300 billion over the next decade.

Democracy Now had an article blaming deregulation and lack of enforcement on the 9 deaths at Rehabilitation Center at Hollywood Hills in the aftermath of Hurricane Irma.  Florida Governor Rick Scott has now directed the Agency for Health Care Administration to terminate the nursing home as a Medicaid provider.   It is incredible that Rick Scott blames everyone except himself.  See article at Miami Herald stating that Governor Scott deleted the messages from the nursing home begging for his help.

Scott gave out his number to nursing homes and assisted living facilities ahead of the hurricane so administrators could report concerns, according to a timeline released by Scott’s office. In the days following Irma, the staff at the Rehabilitation Center at Hollywood Hills called four times. But the messages they left the governor were ignored and then deleted.

New details about the nursing home include the fact a number of safety violations had already been reported at the facility, including two violations about its backup power capabilities—this was before the storm. However, Scott’s administration did nothing.

Unapproved work was done without city permits to the air conditioning and back-up generator systems.  City building officials say they discovered a temporary generator had been placed outside the facility and wired into the building without the necessary city permits.  The city also says officials discovered the air conditioning cooling tower was replaced without a permit — also a violation of the city’s building code.

Florida Power & Light refused to speed up its response to senior living facilities because Scott never listed nursing homes as critical facilities in power outages.

The main owner of the nursing home, Dr. Jack Michel, also has a history of running afoul of healthcare regulators. In 2006, the Justice Department fined another hospital that Michel runs, the Larkin Community Hospital, $15.4 million over civil fraud allegations.

“And it raises questions and concerns, not just about what happened in this particular situation, but how all nursing homes in Florida are regulated, and whether we’re going to require accountability and transparency, and whether nursing home owners, like the owner of this particular facility, that have a history of abuse should even be allowed to operate healthcare facilities. Certainly, things like putting them higher up on the FPL list and requiring facilities to have standby generators that would run air conditioning systems would make a whole lot of sense in a place like Florida. But there are broader questions about what we’re willing to allow nursing homes to get away with and what kind of accountability we want to have for the billions of dollars in public money that supports this industry.”

“The problem is that nursing homes are funded by our tax dollars; 70, 80 percent of the revenue that supports this industry is our money through Medicaid and Medicare. And it is simply not appropriate to have an industry that’s on the public dole. I mean, I would say we should question whether it’s appropriate to have an industry that takes care of frail elderly people that is run by for-profit corporations. But if we’re going to do that, then we have to have appropriate regulation that makes sure that staffing levels are sufficient to provide quality care and that nursing home operators are accountable for the money they receive and for standards of care. And that’s a problem that, you know, is not—that’s a day-to-day, 365-day-a-year problem, not just in natural disasters like this.”

“Most of the hands-on care that’s done in nursing homes is done by certified nursing assistants. And they, tragically, subsidize this industry through poverty-level wages and poor healthcare and retirement benefits. It’s a labor of love, but it is a crime that we ask our nursing home residents and our nursing home caregivers to subsidize the activities of for-profit corporations.”