Author Archives: Gpadmin

Linda Searing of The Washington Post wrote the following:

Every 40 seconds, on average, someone in the United States has a stroke — amounting to 795,000 people a year, according to the Centers for Disease Control and Prevention. Most strokes, 80 percent or more, occur when blood flow to the brain is blocked by a clot. Known as an ischemic stroke, it results in brain cells not getting needed oxygen and nutrients, which causes the cells to start dying within minutes.

The other main type of stroke, hemorrhagic stroke, occurs when a blood vessel in the brain leaks or bursts, with the flood of blood putting pressure on and damaging the brain cells. This type of stroke may be caused by high blood pressure (which over time can weaken blood vessel walls) or an aneurysm (a bulge in a blood vessel that bursts).

Both types of stroke can cause lasting brain damage, disability or death, and some 140,000 Americans die each year from a stroke. The likelihood of brain damage and disability increases the longer a stroke goes untreated, making it critical to call 911 and get emergency stroke treatment started as soon as possibleSigns of a stroke usually come on suddenly and may include numbness or weakness in the face, arm or leg, trouble speaking, blurred or double vision, dizziness or stumbling when trying to walk or a very severe headache.

A condition similar to a stroke, known as a transient ischemic attack, occurs when the blood supply to the brain is blocked for a short time (hence its nickname, “mini-stroke”). Though damage to the brain from a TIA is not permanent, it does make the chances of a full-blown stroke more likely. Because of this, the American Stroke Association refers to a TIA as a “warning stroke.”

Nursing home residents and workers may be among the first to receive a coronavirus vaccine, depending on what a federal committee decides. A preliminary plan reveals that critical medical and national security officials would receive any approved vaccines first, followed by other essential workers and those considered at high risk, such as the elderly and people with underlying conditions.

The Centers for Disease Control and Prevention and an advisory committee of outside health experts currently are working on a priority ranking for upcoming vaccines. The committee, which has been deliberating on the vaccine prioritization since April, reports to the director of the CDC. It includes 15 voting members selected by the health secretary who come from immunology, infectious disease and other medical specialties; 30 nonvoting representatives from across the health field; and eight federal officials focused on vaccines.

“This virus disproportionately impacts older adults, particularly those over 80 with chronic diseases, which comprises the majority of the population we serve,” they wrote in a letter to HHS Secretary Alex Azar. AHCA/NCAL added that top priority is warranted for the groups since “those we care for are the most vulnerable to the virus.”

The Covid-19 pandemic has energized calls for a drastic solution: closing nursing facilities altogether. This year, Covid-19 has killed around one in every 35 nursing home residents in the United States—over 50,000 people. More than 1000 nursing facility staff members have also died from the disease. Even in the best of times, the industry struggles with quality care because of short-staffing, poor infection control, and abuse and neglect.

Why do we have these facilities where people are not receiving proper care?” said Susan Dooha, the executive director of the Center for Independence of the Disabled, New York. “Maybe we don’t need them.”

Deinstitutionalization is the effort to expand at-home or in-community care options for disabled people in need of long-term care.  In the US, such ambitions have run up against the for-profit nursing home industry funded by billions of dollars of taxpayer funds through Medicare and Medicaid payouts. That industry is tasked with providing care to vulnerable people in the nation. Institutional care is more expensive, and even though many nursing home facilities suffer from what critics say is a well-documented history of problems.

Advocates say problems have only intensified as large corporations began consolidating nursing home franchises. Around 70% of nursing homes in the US are under for-profit ownership, and, since the 2000s, private equity firms have purchased many facilities, hoping to cut costs and increase profits. One recent analysis, published by the New York University Stern School of Business, found “robust evidence” that private equity buyouts were linked to “declines in patient health and compliance with care standards.”

Nursing homes became commonplace in the 20th century, enabled by twin shifts in American life: government aid for the elderly, and medicine that allowed more people to reach an age where they could actually use it. Such facilities began multiplying shortly after the passage of the Social Security Act in the 1930s, and they expanded with the introduction of federal- and state-run health programs like Medicare and Medicaid in the 1960s. Nursing homes are distinguished by their capacity to provide skilled nursing care and, typically, 24-hour support for residents.

In the early 2000s, policymakers began doing more to prioritize home care for people who might otherwise have ended up in a facility. Emphasis was placed on supporting patients who could receive care in their own homes, either from family members or home health aides. A major 2018 survey from AARP, the aging-advocacy organization, reported that close to four in five Americans aged 50 and above prefer to age at home. “Most older people are anxious about the prospect of moving into a nursing home,” a recent analysis of studies in high-income countries reported, and studies consistently show high rates of depression in facilities.

For years before Covid-19, researchers have warned that norovirus, influenza, and other infections can spread rapidly in nursing facilities. Those risks have increased in recent years, as nursing homes take in more short-term residents who are getting rehabilitation after hospital visits, and who potentially bring infections into the building with them, said Lona Mody, who runs the Infection Prevention in Aging Research Group at the University of Michigan Medical School. In addition, Mody said, “staff members’ compliance to hand hygiene in the past has been not good.”

The scale of suffering during the pandemic has led to calls for change. “We’ve created this system, and now we’re telling all the people who work in it to just make it work. And it doesn’t work,” said Sonya Barsness, a gerontology consultant who works on reforming nursing home culture. “This pandemic,” she added, “has brought light to the reality that the system is not adequate to support the needs of people as they grow older.”

After COVID-19 has prevented loved ones from seeing their family members. Families are pleading with lawmakers in South Carolina, Connecticut, Ohio and other states to allow cameras to see loved ones. The visitation bans are necessary evils but they have negative effects. There is renewed interest in legislation that would allow families to put remote cameras inside the facilities to help see how loved ones are doing. About a dozen states already have laws or regulations in place allowing residents and their families to install video cameras, subject to certain rules.

The cameras allow families to monitor loved ones in real time or make recordings. In most cases, residents can ask that they be turned off for privacy. There are safeguards to protect roommates from being filmed unknowingly. Signs in rooms alert staff and visitors that the cameras are operating.

McKnight’s had an interesting article on what can be learned from the nursing home industry’s response to the coronavirus including increasing communication through online webinars where the staff can answer questions. Communicating effectively with staff also has been key.

“From bolstering communications to supporting staff to stepping in to help residents in the absence of visitors, many providers around the country have used the pandemic not to merely maintain operations, but to improve them.”

“It’s really created a comfort to families that they have a live stream with the facility,” he says. “It’s like putting on a familiar TV show … We didn’t expect that. In a general sense, it’s been a chance to express their gratitude and appreciation for the work we are doing under extremely challenging circumstances.”

“From the very beginning of the pandemic, our response efforts included the widespread and consistent use of Zoom meetings for education, communication and leadership support,” says Cheri Kauset, vice president of customer experience and communications for Tampa, FL-based Mission Health. “We even implemented quick and easy ‘Leadership in a Minute or Less’ tutorials at the beginning of our weekly calls to help guide our community leadership through some of the unique challenges they’re facing.”

Altarum’s Center for Value in Health Care detailed the spending decline in nursing homes this year in a new report. Spending for nursing home care dropped 7.2% from April to May despite other healthcare sectors showing signs of recovery amid the ongoing coronavirus pandemic. Analysts said they expect a gradual decline through at least the end of the year. Overall, nursing home care spending is down 12.7% from February.

The ongoing coronavirus pandemic has the skilled nursing industry in a challenging state right now after new data revealed occupancy at SNFs dropped to 78.9% by the end of April. In March, SNF occupancy had dropped to 83.4%, which were the lowest levels since 2012.

Rhyan also noted that employment in the sector fell 3% and 4% in April and May, respectively, when compared to last year. He added that though the industry is likely seeing increased spending in patients who require care for COVID-19, that’s being offset by a reduction in other types of care. He expects to see a continued decrease in spending as COVID prevalence increases across the country.

“Nursing homes did not have as near of a steep drop that in April, but we are seeing now this persistent decline into May,” senior analyst and report co-author Corwin Rhyan explained that the sector has seen a more “moderate decline” when compared to the other healthcare industries during the pandemic.

The ability for spending in the sector to rebound will depend on the “extent to which nursing homes get the virus under control,” added George Miller, report co-author, fellow and Research Team Leader for Altarum’s Center for Value in Health Care. “That’s a little hard to predict,” Miller said.

The findings also revealed that Medicaid revenue patient per day increased by $10.53, or 4.9%, when compared to April 2019.

If we don’t immediately begin universal testing of nursing home staff and residents immediately, COVID will eventually be in nearly every nursing home in the country where COVID is present in the surrounding community,” warned Harvard Health Policy Professor David Grabowski in testimony to Congress. It is too late by the time any staff member or resident develops symptoms. The Harvard researcher cautioned without universal testing nursing home workers have no idea what they are facing when they come to work each day. One of the barriers to universal nursing home testing, Grabowski said, is federal agencies are giving conflicting advice:

“The Centers for Medicare & Medicaid Services, the oversight agency, wants nursing homes to test workers weekly, but has not made it a requirement. The Centers for Disease Control and Prevention, however, has said that facilities can adjust how often they test workers based on the local prevalence of coronavirus.”

Nursing home staffers need personal protective equipment (PPE) like gowns, gloves, and masks. However, many nursing homes are reusing supplies while some do not have access to the strongly protective N95 masks and have to rely on lower-grade alternatives.

Grabowski said because of the lack of PPE and testing, most nursing homes have been closed to family members since March even though there is no reason that family cannot be tested and trained in the protective devices the same way that as staffers are.

“Nursing homes function better when family are involved in the care of their loved ones. Our research has supported the idea that care improves when a family member visits,” he noted.

In addition to universal testing and universal availability of high-quality PPE, nursing home care could be improved by a robust strategy to attack the critical shortage of workers at the facilities by quickly matching  unemployed workers to the job openings and to continue to develop a pipeline of trained staffers said Grabowski.

The Emergency Support for Nursing Homes and Elder Justice Reform Act of 2020 would renew and reauthorize funding for several programs in the Elder Justice Act of 2009.  Senate Finance Committee Chairman Chuck Grassley introduced the bill that would establish regional strike teams to respond to outbreaks in skilled nursing facilities and extend reporting requirements related to COVID-19 — both for the rest of the year and retrospective to the start of 2020. Nursing homes would be required to use “a portion of any payments received or federal relief funds made available on or after July 1, 2020, for responding to the COVID-19 emergency period” to meet those rules, according to the bill summary.

“Three things: malnutrition, bed sores, and dehydration,” Grassley told Skilled Nursing News. “If you took care of those three things in nursing homes, most people in nursing homes would have a [good] quality of life.”

The bill would also require that the HHS secretary and Office of Inspector General (OIG) compile a list of diagnosis codes that could indicate physical or sexual abuse or neglect of SNF residents, a requirement stemming from a recommendation of the OIG.

Nursing home operators are anxiously anticipating another bailout and windfall in the fourth, and likely final, coronavirus relief package from the federal government. Observers assume Senate Majority Leader Mitch McConnell (R-KY) have a proposal ready to unveil by the time he returns tomorrow. He promised lawsuit protections and further checks to long-term care operators.

Cliff Porter, senior president of governmental affairs for the American Health Care Association, told McKnight’s Long-Term Care News said long-term care providers will be lobbying for delayed paybacks for a Medicare advance payment program. Operators will be pushing for more funding in any “relief” packages, Porter said.

Lawmakers will have just a few weeks before another recess kicks in and attention shifts to the fall elections. McConnell is worried about campaign contributions. Money is at the root of all his concerns.


Consumer advocates and industry experts call for the federal government to address inadequate staffing at nursing homes and long-term care facilities in wake of the coronavirus pandemic and its fatal toll on residents and workers. The pandemic’s toll on nursing homes is a “deadly consequence” of inadequate staffing levels and lax infection control practices, according to Toby Edelman, senior policy attorney for the Center for Medicare Advocacy. She added that CMS must establish and enforce stronger oversight measures.

“The coronavirus pandemic has made all too visible the lethal consequences of poor care and no oversight. We can and must learn from what has gone wrong, and do better in the future,” Edelman said.

The issues that COVID-19 exploited are not highly technical or complex. They are basic issues of training and adequate staffing,” testified Nicole Howell, executive director for Ombudsman Services of Contra Costa and Solano Counties. “Poor staffing in long-term care facilities was the gasoline to COVID-19’s match.” 

Howell also explained that “within the long-term care industry, direct care workers on average earn only $1 to $2 more per hour over state minimum wage, forcing these dedicated people to work 60 to 80 hours per week at multiple locations.”

“Meaning you can have a caregiver that works at one facility where there are active COVID-19 infections who are forced to work at a second location and may transmit the virus to residents,” she added.

David Grabowski, Ph.D., Harvard professor and healthcare policy expert, also stressed the need for providing more resources, such as better wages and more personal protective equipment, to address staffing shortages.

“Staff are frightened given the lack of COVID testing and PPE, and for good reason,” he said. “New federal COVID data suggests that over 500 staff nationally have died from COVID — making nursing home caregiver the most dangerous job right now in America, with a higher death rate than logging workers and commercial fisherman.”

He also emphasized the need for regular testing in nursing facilities and called on the federal government to develop a consistent testing and PPE policies nationwide, and provide resources for facilities to meet those standards.

“Until we get rapid and accurate testing for all staff and residents, we won’t be able to contain COVID. Rather than pushing the logistics and costs of testing and PPE to states and nursing homes, the federal government needs to take ownership of this issue,” Grabowski said.

“If we had testing and PPE in place, we would be able to move safely towards opening nursing homes again to family members,” he added.