Vox reported that most Trump supporters are sick of Obamacare repeal and Obamacare sabotage–60 percent of Americans think it’s a “good thing” that the Senate health care bill failed — and 78 percent expect the Trump administration to “do what they can” to make the law work better.

Even among those who identify as Republican, there is a strong expectation that it is Trump’s job to fix the health care law. 52 percent of Republicans and 51 percent of Trump supporters think that the president and his administration should “do what they can to make the law work.”

The Santa Fe New Mexican reported the history of neglect at Casa Real.  Inspections and investigations paint a troubling picture of life at the nursing home: medication errors, expired food and drugs on shelves, unreported injuries and assault, poor care of wounds, inadequate safeguards against spread of antibiotic-resistant infection, nurse understaffing and more.

Problems also have occurred at the Santa Fe Care Center, a sister facility of Casa Real, according to inspection reports.  A resident at the Santa Fe Care Center was threatened with eviction last year because his family complained about his care, an inspection found. The inspector also reported seeing staff ignore a woman’s repeated pleas for help as she sat in a wheelchair near a nursing station.

The troubles at Casa Real and the Santa Fe Care Center aren’t new. State inspectors in at least the past 15 years have cited serious deficiencies in resident care. The office of the state long-term care ombudsman, which serves as an advocate for nursing home residents, reported 428 complaints against Casa Real and 105 complaints against the Santa Fe Care Center in the past two years. The top complaints dealt with discharge, administration of medications, staff attitudes and failure to deliver ordered care.

State and federal regulators have allowed the homes to continue to operate and accept Medicare and Medicaid payments, although the facilities have faced substantial fines.  Ownership of the homes, now operated by Preferred Care Partners Management Group of Plano, Texas, has changed several times.

The for-profit facilities are the only skilled-nursing homes in Santa Fe that take Medicare and Medicaid payments, meaning area residents must accept conditions at the homes if they cannot afford private-pay nursing and want to stay in Santa Fe.

Conditions at both nursing homes are the subject of a lawsuit filed against their operators by the state Attorney General’s Office, which alleges the homes received hundreds of millions of dollars from Medicare, Medicaid and private payers without delivering even basic care.

The lawsuit alleges that Preferred Care defrauded Medicaid by having insufficient staff to meet the needs of residents at its Santa Fe nursing homes, as well as at facilities in Gallup, Las Cruces, Bloomfield, Española and Lordsburg. Also named as a defendant is Cathedral Rock, former owner of the homes.

The department conducted its last standard health inspection of the nursing home in April and reported 37 deficiencies, more than three times the average number of health deficiencies found in all New Mexico nursing homes. Among the reported problems:

• Medications were not administered at proper doses or on time. One resident was supposed to be given a medication daily but didn’t receive it on 13 days in March. Also, residents didn’t receive medications because the home didn’t have them available. Expired medications were found in drug storage.

• A female resident who was supposed to receive a shower three times a week hadn’t had a shower for a week. “I got a shower cause I was begging for it,” the resident told an inspector.

• Bathroom pull cords for call lights were unreachable if a resident fell.

• Residents were not receiving the number of physical therapy sessions ordered by physicians. “This deficient practice … is likely to increase falls resulting in bruises, lacerations, broken bones, head trauma and death,” the inspector’s report said.

• Food was not served at the proper temperature, and food in refrigerators was older than its expiration date.

Bangor Daily News published a letter from Phillip Bennett, an administrator at Bangor Nursing and Rehabilitation Center.  See below.

As a nursing home administrator, I read with great interest the BDN report “Worn to the Sole” about the Maine woman who protects the dying and can barely make ends meet. This article accurately and empathetically portrayed the daily life of a dedicated CNA in a Bangor-area nursing home. It highlighted her sincere commitment to the residents for whom she cares and the quality of care that comes from an intimate knowledge of their likes and needs, developed over months or years of daily personal attention. And it reflected her pride and confidence in working as a professional caregiver.

But “Worn to the Sole” is aptly named, reflecting the difficulties faced by CNAs in all nursing homes, where the work is hard, the hours sometimes unexpectedly long, and wages insufficient to pay the bills and provide a satisfactory living.

Maine nursing homes face an intractable CNA shortage with no precedent, and they have been struggling for some time with how to deal with it. The CNA hourly wage, adjusted for inflation, has fallen over the last 10 years — a long time during which every dollar a CNA brings home buys less — and in any case, it has never provided much more than a subsistence wage.

Together with the stress the job entails (both because of reasonable and unreasonable supervisor and family member expectations) and risk of injury (Maine CNAs are injured as often as construction workers), there has been a disincentive for CNAs to remain in the field — and they are either leaving the field altogether or for better pay elsewhere.

 As nursing homes see CNA vacancies appear with greater frequency, they turn to temporary staffing agencies, often paying twice as much to maintain minimum staffing. The agencies fill the vacancies by paying temporary CNAs a higher hourly wage. The work the agencies offer may be less certain, and benefits may or may not be available, but CNAs need a better income. Many CNAs have moved to those agencies for the higher hourly pay they receive. Many end up working in nursing homes in the same area, which are befuddled by their lack of staff and what to do about the matter. Additionally, to reduce the extraordinary and ongoing costs of temporary CNAs, nursing homes require additional hours of work on short notice, a practice all too common in health care but unacceptable in other walks of life.

It seems to me that the answer is fairly clear: CNAs in nursing homes need to be paid more. The CNA shortage is a long-term structural change caused partly by nursing homes not paying enough to attract and retain workers — a problem compounded by requiring additional shifts or weekends to cover staff shortages.

Bangor Nursing and Rehabilitation has done both — significantly increasing CNA wages and eliminating the requirement for them to stay for additional shifts. It makes no business sense to pay exorbitant fees for CNAs from staffing agencies while waiting for MaineCare, the state’s Medicaid program, to increase reimbursement rates. It is ethical and practical to pay better wages. Nursing homes already pay more for temporary CNAs than if they paid a higher wage to recruit or retain their own staff. Not to do so flies in the face of reason, regardless of state legislative action.

Our experiment is early. We still have unexpected turnover, but we do receive more applications for vacancies and fill them faster than before, and have greater employee satisfaction by not mandating additional hours. We also hope to improve our retention by offering better wages and not requiring our employees stay beyond their scheduled shifts.

Perhaps an independent nonprofit can do this easier than a corporate for-profit entity, but this change is inevitable. The sooner CNAs make more and have reliable hours, the more likely nursing homes will be able to reduce their dependency on staffing agencies and reduce their wage expenses. In the process they will likely find satisfaction in caring for their employees as those employees care for their residents. It is the right thing to do.


KTLO reported that additional charges have been filed against a nurse who fled from law enforcement officers earlier this month following a traffic stop after police responded to a complaint of an intoxicated driver on July 16. When they located the vehicle and attempted to conduct a traffic stop, the driver refused to stop, and a short pursuit ensued.

The driver, Geneva Liveley, was apprehended and taken into custody. An inventory of the vehicle revealed numerous prescription medications belonging to other individuals, a loaded firearm, drug paraphernalia and cash totaling $1,110.

Liveley was charged with simultaneous possession of drugs and firearms, possession of a controlled substance (Hydrocodone), both felony counts, as well as misdemeanor charges.

Chief Manuel says an investigation began into Liveley’s possession of prescription medications belonging to other individuals. It was learned she worked at a local nursing home and stole medications from residents. The medications in her possession were logged by her as being received by the residents.

Liveley was arrested again and charged with four felony counts of controlled substances-fraudulent practices and six misdemeanor offenses.

Goupstate reported the arrest of Natalia Mikhailovna Roberts, a caregiver at Lake Emory Post Acute Care in Inman, S.C.  Roberts is accused of taking medications from patients and charged with two counts of violating drug distribution laws and theft of a controlled substance.

Warrants from the Department of Health and Environmental Control accuse her of intentionally taking doses of hydrocodone and oxycodone that were intended for patients.

In one incident on May 27, records reflect that there were 78 doses of oxycodone for a patient when there should have been 96 tablets remaining, according to a warrant.

Another warrant states that on June 17, a page was missing from a controlled medication utilization record for another patient regarding hydrocodone doses.

Until a few months ago, Lake Emory was designated as a Special Focus Facility and was even fined almost $200,000 on Jan. 11, 2017.  Lake Emory is owned and operated by Fundamental Long Term Care now known as Hunt Valley Holdins, a national for-profit chain with hundreds of nursing homes in numerous states.

New York Magazine reported on the stability of ObamaCare despite Trump’s reckless attempts to sabotage the popular health care act.  Several independent private-sector analysts have concluded that the exchanges are not in a death spiral, and the Trump administration has actually admitted this.  However, Americans on the exchanges are still unsure of what options they’ll have when the 2018 open enrollment period start on November 1.

Health and Human Services Secretary Tom Price said he’s still open to abusing his regulatory authority to waive the individual mandate. America’s Health Insurance Plans blasted that idea when it was part of the Senate’s “skinny repeal” plan, telling Congress, “Policies that do not stabilize the market and simply drop incentives for people to buy coverage will repeat what we have seen in the past: premiums will rise rapidly, few or no affordable coverage options will be available and more people will be uninsured.”

The other problem is Trump’s childish threats to stop paying cost-sharing reductions, the subsidies to insurers that offset the cost of covering low-income enrollees. In June the actuarial firm Oliver Wyman projected that up to two thirds of 2018 rate increases could be attributed to “the uncertainty surrounding continued funding of cost sharing reduction (CSR) payments and the question of how the relaxation of the individual mandate will impact enrollment and risk pools.” Congress should appropriate money for CSR payments, and there’s talk of a bipartisan health care bill that would do just that.

“In the 39 states that use the federal marketplace, insurers must submit their revised premium requests by August 16. Trump could refuse to pay when the next round of CSR payments is due on August 21 (or again on September 20). Then on September 27 insurers must make their final decision on whether to sell Obamacare plans. (Vox notes they’d still have an opportunity to pull out if the Trump administration sabotages Obamacare between September 27 and the start of open enrollment on November 1.)”

The Huffington Post had an article from Robyn Grant, Director of Public Policy and Advocacy, The National Consumer Voice for Quality Long-Term Care.

Last month, the federal government signaled its intention to roll back protections critical to the health, safety and welfare of vulnerable nursing home residents. The rule they want to eliminate bans the use of pre-dispute arbitration agreements. These agreements require older adults, people with disabilities and their families to waive their rights to the judicial system before a dispute even arises. Then, any dispute, even abuse or neglect, and regardless of how egregiously they’ve been harmed, is forced into secretive arbitration proceedings.

Typical nursing home claims involve injuries such as pressure sores that lead to infection; amputated limbs; suffocation on bedrails and other restraints; choking;; sexual assault; renal failure and other conditions caused by dehydration; malnutrition; severe burns; gangrene; and painful, immobilizing muscle and joint problems resulting from long-term inactivity. All of these are avoidable conditions that are the result of negligence or even willful misconduct by long-term care facilities.

These forced arbitration agreements are presented to prospective residents and their families during the admission process, an extremely difficult and stressful time. Individuals typically feel compelled to sign because they are under extreme pressure to be admitted and the implied message is they must agree or be refused care. To make matters worse, under the recent government proposal, this message would no longer be implied. Nursing homes could refuse admission to a resident whose family, acting on their behalf, is unwilling to sign away their rights. This holds residents hostage – they must agree to give up their rights in order to have essential care and a place to live.

Arbitration stacks the deck against residents. The contracts typically allow the nursing home to select the arbitrator, the state in which the arbitration will occur and the rules for the arbitration process. There is a strong incentive for arbitrators to find in favor of the facility since this can assure them of repeat business. As a result, residents often lack meaningful ability to hold the nursing home accountable for mistreatment and harm.

Nursing facilities insert pre-dispute arbitration clauses in their contracts to ensure that they will never be held publicly responsible for their actions, and to limit any penalties imposed for wrongdoing. Arbitration proceedings are held behind closed doors and are confidential. The public, including those looking for a nursing home – will never know the nursing home’s full track record ― no matter how bad ― because it is hidden. Arbitration shields poor performing facilities from the negative impact on their reputation, public opinion and pressure that could serve as a deterrent to substandard care.

The U.S. Census Bureau estimates that by 2030, one in every five U.S. residents will be 65 years or older; almost half of these Americans are likely to spend some time in a nursing home. We must stand together to protect the rights and care of frail, at-risk nursing home residents. More Americans must lend their voices to this cause. Tell our policymakers to reinstate the ban on mandatory pre-dispute arbitration agreements that protect nursing homes, but not those entrusted to their care.


The Times Leader reported that several Attorney Generals are banding together to protect vulnerable seniors from the Trump Administration’s reversal on banning forced arbitration onto unsuspecting nursing home residents.

Pennsylvania Attorney General Josh Shapiro and 16 other Attorneys General sent comments to the Center for Medicare and Medicaid Services, recommending that CMS keep in place a rule that prohibits pre-dispute arbitration clauses in nursing home and long-term care contracts. Pre-dispute arbitration clauses require seniors to waive their constitutional rights to go to court to resolve any dispute with a nursing home.

In the comments sent Monday to CMS, the attorneys general state:

Pre-dispute binding arbitration agreements in general can be procedurally unfair to consumers, and can jeopardize one of the fundamental rights of Americans; the right to be heard and seek judicial redress for our claims. This is especially true when consumers are making the difficult decisions regarding the long-term care of loved ones. The contractual provisions may be neither voluntary nor readily understandable for most consumers.”

“I have the responsibility of protecting our most vulnerable citizens, including seniors living in long-term nursing care facilities,” Shapiro said in a news release. “If we allow nursing homes to include pre-dispute arbitration clauses in admission contracts, our seniors will have less access to the courts and to justice. I won’t stand by while seniors lose their rights.”


The Dayton Daily News reported that Pristine Senior Living of Beavercreek sent a letter to their families informing them that their employee, Steven Douglas McDowell, a licensed practical nurse, is facing sex charges involving residents at the facility.  At least, three Pristine Senior Living residents have been identified as possible victims.

McDowell has also been indicted on 11 counts of illegal use of a minor in nudity oriented material, one count of voyeurism and three counts of gross sexual imposition, according to the prosecutor’s office.

The Business Times reported the financial difficulties of one of the major national for-profit nursing home chains.

US healthcare landlord Quality Care Properties Inc said on Friday that it can seek receivership for the country’s second-largest nursing home chain, HCR ManorCare, after it failed to make a US$79.6 million payment for current and past rent.

In a statement, Quality Care said it had delivered a notice of default to HCR ManorCare, its main tenant, regarding the missed payment, which Quality Care said triggers immediate payment of $265 million in additional overdue rent.

Private equity firm Carlyle Group bought HCR ManorCare in a 2007 leveraged buyout for $6.3 billion and sold the properties to HCP for $6.1 billion in 2010.

I guess they are done siphoning funds away from patient care to line their own greedy pockets.