The Hill reported that health insurers are finding success in ObamaCare this year despite Trump’s continued attempts to sabotage the insurance market.  Health insurers are planning to expand their offerings in many states, defying expert’s predictions.  For example, new insurance startup Oscar Health filed to sell ObamaCare plans in Florida, Arizona and Michigan for the first time, and will enter new markets in Ohio, Tennessee and Texas.  Some smaller insurers are also entering the market, such as Bright Health in Tennessee and Presbyterian Healthcare in New Mexico. It will be the first time Bright Health is selling plans in Tennessee, while Presbyterian is returning to the state exchange after leaving in 2016.

Experts have been hailing these developments, saying that insurers have finally figured out how to become profitable in the ObamaCare marketplace.  “We have finally reached the point where insurers are making money in the [ObamaCare] marketplaces,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation.

If not for the still significant political and legal uncertainty, we’d be seeing a very robust market right now,” he said.

Insurers are pointing the finger at Trump’s changes to ObamaCare, arguing they will pull healthier people out of ObamaCare’s exchanges.  Premiums this year are reflecting that uncertainty.  Democrats have pounced on premium increases ahead of the midterm elections. With the GOP now in control of government, Trump and congressional Republicans will shoulder the blame for the hikes.

 

A few weeks ago, a disruption was reported late in the morning in Fountain Hills, Arizona, where police soon found a 72 year-old man shot twice in his home. Earlier that morning his mother, who had been up for days upset about a dispute they’d been having, walked into the room where her son and his girlfriend slept, and killed them. What was the object of this dispute? Fear of being neglected at a nursing home.

Before the incident, Anna Mae Blessing had been living with her son and his girlfriend for about six months. The two didn’t get along very well and on multiple occasions each one had called the police, both separately suspecting the other of potential violent behavior. Within the house, there were 13 guns, 11 which belonged to the unidentified son and 2 which belonged to Blessing.

In the days leading up to the murder, Blessing’s son informed her that she had become too difficult to live with and he was going to place her in the care of a nursing home. This made Blessing extraordinarily angry, knowing that oftentimes those who live in nursing homes are unhappy or not taken care of as well as they’d like to be. So in response, after days of thinking and growing in her anger, Anna Mae Blessing took her two pistols, hid them as she walked into her son’s bedroom, and shot him twice before his girlfriend intervened and prevented any more use of the weapons before she herself fled the scene. Reportedly, Blessing went back to her bedroom and waited in her chair until the police arrived, where she said “You took my life, so I’m taking yours,” as they took her away. Later, however, she also said she wanted to kill herself after committing those crimes.

The fear of being sent to a nursing home certainly wasn’t the only cause for this crime, but it remains a significant factor. Anna Mae Blessing had trouble living with her son, but she truly believed that leaving him for an assisted living facility would take away her life completely. She knew how people are often treated at nursing homes, with poor living conditions and bad food sometimes being just the tip of the iceberg. There were always stories of abuse and neglect and people developing illnesses and injuries they never should have had. It’s unacceptable that Blessing felt she had reason to kill her son when around the corner lay a nursing home where her life would be taken away.

The New Tribune reported the 10 year prison sentence for James Burkhart, the former CEO of a company that operates dozens of Indiana nursing homes, for his role in kickback schemes involving nearly $20 million.  A federal judge ordered the prison term for Burkhart, who pleaded guilty to charges that included conspiracy to commit fraud, violate health care anti-kickback laws and money laundering.

Burkhart was the CEO of Indianapolis-based American Senior Communities until he was fired soon after federal agents raided his Carmel home in 2015.  Burkhart wasn’t satisfied with his $1.4 million annual salary and ran fraud and kickback schemes that enabled him to live a lavish lifestyle.  Burkhart received $7 million in bonuses during the six years he led the fraud and owned two vacation homes.

The charges against Burkhart included schemes having vendors inflate their bills to ACS and pay the excess to him or submitting bills from shell companies he formed for fictitious services.  Hope he rots in jail.

Herman Devine had been staying at Carolina Care Center of Cherryville for years when he broke his leg in a fall there and later died in January of 2016. After suffering a previous fall only 11 days before this one, Devine attempted to walk around unassisted, which led to multiple injuries including an unidentified fracture in his right femur. The injury went unnoticed at the home for 7 hours with Herman’s pain relief limited to Tylenol before the facility’s staff finally took notice of his yelling in pain through the night.

Devine was at risk for falls, and the nursing home was made aware of that from the beginning of his stay. They were also aware of mental issues he had, like disorientation and confusion, which could lead to injury if he wasn’t properly supervised. There was even documentation within the facility, not long before the incident, that Devine had a history of and was prone to more falls. Knowing this, Carolina Care Center should have been able to prevent the injury which led to his death.

But this wasn’t the only example of this nursing home neglecting Herman Devine. Before the broken leg there were also skin tears and weight loss for Herman, in addition to the “mental anguish” of being ignored and mistreated by the nursing home staff.

Unfortunately, stories like this are all too common, especially for families who have no choice but to depend on a single facility, which could be underfunded or understaffed. Hopefully, though, the story of Herman Devine’s case will show the way some nursing home residents are treated in contrast with the way they deserve to be treated.

 

A while ago a report went out that three South Carolina residents had been charged with 38 counts of serious crimes including healthcare fraud, money laundering, identity theft, and wire fraud. As a part of the schemes, Cameron Banks and his partners Angela and Solomon Pyatt applied for loans in the names of patients at the dentistry practice where Banks worked, converted funds for personal use, and falsified many other forms of documentation and applications in order to illegally obtain money. Each crime separately is worth 10 or more years in prison and at least $250,000 in fines. In the past Banks, who’s been known to go by the alias Reggie Staggers, had also been charged for federal tax crimes, as well as arson in relation to a church at which he was pastor.

Cases like this of healthcare fraud and identity theft are more common than one might think. While it sounds like something for which you’d have to go to great lengths and pains, maneuvering and jumping through government hoops to trick a whole system into giving you money, the reality of healthcare fraud is still this: people like Cameron Banks, in addition to real doctors and nurses, are able to mischarge for procedures they may never have performed, pretend to be patients in order to make claims on their behalf and receive that money, and find many other creative ways to siphon funds.

The world of nursing homes and elder care isn’t excluded from this crime either. In fact, because the elderly often lack the ability to vouch or stand up for themselves the same way a normal patient would, it becomes even easier for healthcare workers to engage in fraud and more difficult for the government to catch them. The most popular form of this comes from home healthcare services where the physicians and other healthcare workers will have patients sign documents stating they were attended to at home or helped in ways in which they weren’t. The workers will then receive payment for services which were never provided and slowly build up their personal funds.

When someone has trouble breathing in an emergency situation, doctors often employ intubation, a method of helping patients to breathe by inserting a tube down their throat and connecting them to a ventilator to help or replace the process of breathing. Because of its function, many people think of intubation as a miracle procedure — or at least one that works well. It’s supposed to help keep people in serious, painful conditions alive. But, especially for elderly and geriatric patients, that might not be the case.

For an elderly patient, whose condition would be easily weakened or changed, the process of intubation can be particularly invasive. Aside from removing the patient’s ability to speak and sedating them, the process also shows the potential of causing damage and danger to the lungs, throat, and other vital bodily functions.

The New York Times published an article about the unknown dangers of intubating elderly patients at hospitals. It shows, through evaluation of different scientific studies, that elderly patients rarely benefit from intubation. Instead, they are at risk for many more complications as well as pain, injury, and even death as a result of those complications.

In realizing the danger intubation poses toward older patients, doctors have looked to methods of “noninvasive ventilation” as alternatives to intubation, which would cause less physical distress to the body. For example, BiPap devices fall under this category, using a mask over the face instead of a tube down the throat to facilitate healthy breathing. It also gives patients better options in terms of communicating and controlling their own faculties, in addition to running a much lower risk of death or extensive treatment after it’s employed.

When it comes to elderly patients, it’s easy to think of them as an exception. If they don’t naturally react well to a process like intubation, any outsider could think their fragility or susceptibility to pain would be unavoidable due to their age or preexisting conditions. On the other side, family members of elderly patients who have to choose whether to allow intubation are likely to believe their loved one will be an exception to the risks involved in the procedure and follow the more dangerous path.

But these patients don’t necessarily have to live with those risks and pains, and their family doesn’t necessarily have to make such a heavily weighted decision. If innovations in noninvasive ventilation continue to come through, many elderly patients and their families will be saved serious heartache.

Listed as one of America’s poorest nursing facilities, Wentworth Rehab in Chicago has a reputation for miserably insufficient maintenance and patient care, as reported in the Chicago Tribune. It’s known for events like the death of Letasha Mims, whose family finds Wentworth to blame for her passing after she became desperately ill during her time there.

Even more recently, a 79 year old man was allowed to smoke while using an oxygen machine at Wentworth, which eventually caused a fire that killed him and caused massive damage in the nursing home. It was reported that the man had a history of destructive behavior and should have been more carefully surveyed for such danger, and also that the staff had acted in a dangerously negligent manner, with one nurse looking on carelessly as the man was burning to death and another nurse attempted to save him.

To those familiar, these kinds of events would not be surprising. None of this even mentions the seeming inescapability of insects and rodents in Wentworth Rehab. Inspectors have reported unidentifiable food being served to patients. Residents can be seen plainly in areas of the nursing home with unimaginably poor personal hygiene. When asked about any of this, Wentworth’s parent company, Alden Management Services, will either deny its facility’s negligence or decline to comment altogether.

There are plenty of bad nursing homes in the United States, many on the same lists as Wentworth. There are even plenty of other bad nursing homes in Chicago, where it’s not hard to imagine a need for affordable or accessible nursing homes. But with its history of lying, neglecting, and ignoring, Wentworth Rehab stands out as a hallmark of bad behavior in nursing homes and a way of looking at any facility’s character.

Freelance Contribution by Jessica Walter

Only a third of America’s fifty million senior citizens are living independently, outside of nursing homes. If you’re concerned about being able to afford a nursing home and healthcare when you are 65 or older, you should know that modern financing options are out there. While saving for retirement is the best defense against financial problems during your golden years, there are innovative ways to find money, even if you haven’t saved enough.

Move to a Smaller Space

The median price of a South Carolina home is $157,600 according to Zillow. A home is typically the biggest expense that a person has and plenty of costs are involved with maintaining a property. When you choose to downsize, you’ll pay less per month for your mortgage and this will allow you to put more money away for the future. If you don’t want to move, consider upgrades which make your home less expensive to run, such as energy-efficient home improvements.

Get Rid of Debt

Debt means interest and these payments can really add up. For this reason, you should focus on eliminating debt. When you do, you’ll be primed to put money away for retirement, rather than giving it to lenders. One ultra-modern option is debt consolidation. By getting a debt consolidation loan, you’ll be able to make one monthly payment on your debt, for an interest rate that is likely lower than what you’re used to paying. The California Teacher’s Association asserts that it’s possible to save ten percent on interest when you consolidate.

Negotiate with Nursing Homes

If you’re advocating for a senior that you care about, you should be aware that it’s possible to negotiate with nursing homes.There is often room for negotiation for the long-term costs of care. For example, a nursing home will be willing to accept a private pay rate that’s lower than average, provided the rate remains higher than the rate from Medicaid.

Get an Affordable Loan

Big banks aren’t your only option when it comes to accessing funds for long-term care. These days, a lot of alternative lending solutions are available, from personal loans from third-party financiers to peer-to-peer lending and beyond. Finding a low interest rate is what it’s all about. Think outside of the box by exploring alternative lending solutions that don’t come from major financial institutions. Then, compare interest rates and loan terms to what the big banks are offering.

Start Planning for Retirement

Thinking about the cost of retirement can be stressful. Careful planning, well ahead of time, is the best way to take the pressure off. However, it’s never too late to start thinking about how to finance the cost of a nursing home, which may run as high as 7.500 USD per month. So, why not come up with a financial plan for retirement today?

The Star Tribune reported that nursing home employee Francisco Javier Ramirez, a nursing assistant at the Good Samaritan Society nursing home, was transferring a female resident, Evelyn Augusta Schweim, out of a bathtub using a mechanical lift chair but failed to follow correct procedures. The resident slid out of the chair — which was raised to its highest level of about 5 feet — and then sustained multiple fractures. The fall was so severe that the woman’s left foot was almost detached from her leg, and the bones of her left leg were visible, according to a Minnesota Department of Health investigation last year of the incident. When she was found, pools of blood had formed around the woman’s ankle and she was complaining of knee and neck pain, the report said.

 After the fall, Ramirez again violated safety protocols by moving the resident away from the door by pulling on her gown, and then leaving her alone in the bathroom as he went to get help, state investigators found.  Schweim, died on Sept. 17 from complications of multiple skeletal fractures resulting from the fall.
 The state Health Department investigation concluded that Ramirez violated multiple safety protocols and was responsible for neglect. The violations include failing to obtain assistance from a second staff person, as required; failing to operate the mechanical lift properly; and leaving the resident alone in the bathroom instead of using his phone or walkie-talkie to call for help. Ramirez also violated protocol by raising the woman to the highest level on the lift. Standard procedure was to lift the chair no higher than 1 to 2 feet, according to the criminal complaint.
Ramirez has been charged with second-degree manslaughter, two counts of criminal neglect and one count of mistreatment of patients.

The Toronto City News reported the tragic and preventable death of Danny McNeill trapped in his bed rail, his 69-year-old body fighting desperately to escape the very rails that were supposed to protect him.  Danny McNeill died alone at the Maple Manor Long Term Care Home in Tillsonburg.

According to Health Canada there have been 25 reported incidents involving bed entrapment over the past two years, seven were fatal. Since 2008 Health Canada has issued several safety communications about the use of bed rails as restraints in hospitals and long term care homes — most recently in April 2017 — yet they are still used in most homes and hospitals.  The home has been cited for safety violations involving both the use of restraints and bed rails in the past — including in 2016 when inspectors found that the “licencee (had) failed to ensure that no resident of the home was restrained by the use of a physical device.”

In 2015, the home was cited for failing to ensure that where bed rails were “used in the home (it) had taken steps to avoid patient entrapment” and later that year, 36 of 108 beds were identified as “failed” — in some cases because of a lack of mattress keepers or rails that required ongoing tightening.

“That’s why I’m here, to let people know that they’re being used. Our family members are using them and getting their heads trapped in them,” Kevin McNeill told CityNews. “I’m disgusted.”

“He got trapped between the bars of his bed rail and mattress. That was the call. They said he had died and that was pretty much it,” McNeill says, recalling the phone call he got from the home last Sunday.

McNeill doesn’t know why the restrains were in use. He says an alarm should’ve sounded when his father fell from the bed.

“If he was to fall off the bed or make a movement, the alarm would go off and notify the nursing station and buzz at the bed as well. In the case of falling, the alarm goes off,” he explains.

“The alarm should have been going off as soon as he probably left the area of the pad. He made it to the floor and got his head trapped for too long. That was the case. We really don’t know how long it took until that alarm was heard. I don’t know if they heard.”

Staff at the home told Ministry of Health inspectors that they had received no training on rail safety.

McNeill is still very much grieving the loss of his father but says the practice of using bed rails has to be re-examined.

“Maybe they’ve got to change those rails and make sure we’re not using them as restraints, just using them for getting out of bed. i didn’t know what they were used for until I did some research myself. gotta let people know.”