The The Urban Institute estimates millions of Americans will lose Medicaid coverage if Republicans Block Grant Medicaid. Block Granting Medicaid is one of the ways Republicans want to pay for tax cuts for their wealthy donors.

What will happen to the millions of future older Americans who are in danger of losing Nursing Home care through Medicaid.  Kaiser Family Foundation shows:8617-02-figure-1.png

“… According to 2012 estimates, among people age 65 and over, an estimated 70 percent will use LTSS, and people age 85 and over – the fastest growing segment of the U.S. population – are four times more likely to need LTSS compared to people age 65 to 84.6,7 Approximately seven in ten people age 90 and above have a disability, and among people between the ages of 40 and 50, almost one in ten, on average, will have a disability that may require LTSS. …”II

The other sets of facts show Medicaid represents the majority of Long Term Care”.

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Vox had two great articles on the opiod crisis.  Drug overdoses now kill more Americans than HIV/AIDS did at its peak. In 2015, more than 52,000 people died of drug overdoses, nearly two-thirds of which were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. That’s more drug overdose deaths than any other period in US history — even more than past heroin epidemics, the crack epidemic, or the recent meth epidemic. And the preliminary data we have from 2016 suggests that the epidemic may have gotten worse since 2015.  Vox has maps and charts that tell the story:

  1.  Drug overdoses now kill more people than gun homicides and car crashes combined.
  2. Drug, painkiller, heroin, and other opioid overdose deaths are still on the rise.
  3. Opioid overdoses are one reason US life expectancy declined for the first time in decades.
  4. The epidemic is much worse in some states than others.
  5. By and large, the drug overdose epidemic has hit white Americans the hardest.
  6. Americans consume more opioids than any other country.
  7. In some states such as South Carolina, doctors have filled out more painkiller prescriptions than there are people.
  8. Drug companies have made a lot of money from opioids.
  9. At the same time, Americans report greater levels of pain.

A Senate investigation into the pharmaceutical companies’ role and responsibility for the nation’s worst drug overdose crisis in history:  Sen. Claire McCaskill (D-MO), the top Democrat on the Senate Homeland Security and Governmental Affairs Committee, announced that she is requesting marketing, sales, and addiction study material from the companies behind America’s top five opioid products. The investigation, she said, will draw out the role that opioid manufacturers played in causing the epidemic and letting it continue.

As USA Today noted, McCaskill will need Republican support on the committee to be able to subpoena opioid makers’ documents should the companies not comply with her requests.

Drug manufacturers played a major role in the epidemic. By marketing their opioid painkillers as safe and effective, they convinced doctors to prescribe painkillers in droves to patients. That allowed the drugs to proliferate, leading not just to widespread painkiller misuse but also to the misuse of more dangerous opioids like heroin and illegally manufactured fentanyl. With this, the risk of overdose increased — spawning the opioid crisis we have today. As opioid painkiller sales increased, more people got addicted — and died.Annual Review of Public Health

Much of this was the result of misleading marketing by major drug companies. In fact, Purdue Pharma, a producer of “hillbilly herion” OxyContin, in 2007 was forced to pay hundreds of millions of dollars in fines due to its false claims about opioids.

In wide-ranging investigations, the Los Angeles Times has uncovered more evidence of how Purdue’s misleading advertisement played out at the ground level. It found that Purdue exaggerated the effectiveness and safety of OxyContin, while covering up any criticisms and complaints about the drug. As a particularly egregious example of why Purdue and its marketers did this, one sales memo uncovered by the Times was literally titled “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!”

Other opioid makers have faced similar allegations. Insys, a drugmaker, allegedly pushed its fentanyl spray for uses far beyond late-stage cancer pain treatment, according to McCaskill’s office. A sales representative claimed that the company’s informal motto was, “Start them high and hope they don’t die.”

A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.

Most Americans (50%) get health insurance through their work, and another 34 percent rely on the government through Medicare or Medicaid. Because of the ACA, only 9 percent are uninsured. The rest — those who are too young to qualify for Medicare and too rich to qualify for Medicaid but want to buy insurance — deal with insurers that sell plans to individuals.

The Obamacare exchanges created to help some 13 million Americans buy quality and affordable insurance outside of the employer-based market. And the overwhelming majority of these people happen to live in rural parts of the country — the very same places that voted for Donald Trump.

Map of counties with 1 ACA insurer and how they voted in the 2016 election

Will Trump undermine these marketplaces or try to make them work by messing with or weakening provisions like the individual mandate or the subsidies?

If Trump wants to reduce the whole structure of the ACA into unworkable rubble so that Democrats will have to agree to replace it, the administration will have to sabotage it. Unfortunately, there’s a pretty easy path for them to do it.

First, the administration could eliminate enforcement of the individual mandate, which requires Americans to buy health insurance or pay a tax penalty.

Second, the administration could cut outreach about open enrollment.

Third, if Trump wants to throw Obamacare’s exchanges into chaos, he could choose to stop defending a lawsuit filed by the House of Representatives that attempted to halt the government from making what are known as “cost-sharing reduction” payments to insurers. Under the Affordable Care Act, carriers are required to limit how much low-income customers pay out of pocket for things like deductibles and co-pays. In return, the companies are supposed to get direct subsidy payments from Washington to cover the expense. Those checks are worth billions to the industry, since more than half of marketplace enrollees benefit from cost-sharing reductions, and are absolutely essential to making the marketplaces work.

Republicans in the House of Representatives sued the Obama administration a few years ago to stop the payments, arguing that because Congress had never technically allocated the money to fund them, the government was disbursing the cash illegally. If Trump drops the appeal, it could have profoundly damaging consequences for the insurance market. Insurers would still be required to keep offering low-income customers their discounts but wouldn’t be compensated for it. The result would be financially disastrous.  Ending the cost-sharing reduction payments would require an active decision on the Trump administration’s part.

McKnights reported that Centers for Medicare & Medicaid Services (CMS) are directing nursing homes to submit of payroll based journaling data well ahead of the May 15 deadline in order to catch errors. Providers will have until that date to submit data for the fiscal quarter lasting from Jan. 1 to March 31, 2017.

CMS staff told attendees of the Skilled Nursing Facility Open Door Forum call to not hold out until the deadline in order to see if there are “errors and issues” and leave time for corrections if needed.

While providers’ compliance with the program has not been added to their Five-Star rating yet, CMS officials noted the addition of a badge to the Nursing Home Compare website that will show whether or not a facility has submitted staffing data. A green badge indicates that the facility is already participating in the PBJ program; gray means a facility isn’t participating yet.

The badge also includes a note that the staffing reporting program will “be on Nursing Home Compare by early 2018.”

The Star Tribune reported the Minnesota investigation that discovered Kenneth Allers was neglected to death.  A nurse stood by and did nothing as Allers suffered numerous violent and painful seizures in his final hours.  The nursing home facility ignored pleas from his family who were begging the caregiver to intervene. The attacks left an unresponsive Allers biting off pieces of his tongue and inner cheek and bleeding from his mouth, but the nurse refused to alert his doctor or give him medication to ease his anguish or fight off the seizures, the state found.

A Minnesota Health Department investigation lasted six months and ruled that the nurse’s neglect was to blame for the anguish that 58-year-old Allers endured for at least 11 hours at the Sterling Park Health Center.

His final hours were consumed with at least seven seizures, a few lasting less than a minute but one going on for 1½ minutes followed by another lasting 2 minutes, the state investigation noted.

At one point as the seizures kept coming, according to the state report, a witness said to the nurse, “It looks like [Allers] is in pain!” The nurse replied, “Yes, it does” and walked out of the resident’s room without another word.

Allers only received pain medication after a new nurse came on duty; his seizures stopped soon afterward.

River Front Times reported the scam by nursing home caregiver De’Janay Noldon. She pled guilty to federal fraud charges for stealing her victim’s personal information while working at Seniors Home Care. She opened lines of credit in the person’s name and used them to shop and pay her own bills as well as bills for her family.

Noldon also logged into the victim’s Edward Jones account in hopes of stealing the senior’s savings, federal prosecutors say.  The crooked caregiver pleaded guilty to mail fraud and aggravated identity theft. Investigators say they have identified another twelve elderly victims and six financial institutions defrauded by Noldon. She’s believed to be responsible for losses totaling about $30,000.

Noldon is scheduled to be sentenced on June 27. She faces a maximum sentence of 22 years in prison and a $250,000 fine.

Reuters reported that more than 20,000 people living in U.S. nursing homes experienced serious injuries to the face last year, mainly from falling and hitting hard surfaces or while getting in and out of bed, a recent study suggests. Face injuries can be particularly serious for elderly people because they can affect vital functions like speech, swallowing, sight, and even breathing, said Dr. Peter Svider, a researcher at Wayne State University School of Medicine in Detroit, Michigan.

Nursing homes programs focused on fall prevention should concentrate more on averting these injuries that can cause considerable pain and disability, the research team writes in JAMA Otolaryngology – Head and Neck Surgery.  SOURCE: bit.ly/2n8c8jI JAMA Otolaryngology – Head and Neck Surgery, online March 16, 2017.

Nursing homes can reduce the risk of falling by doing exercise or physical therapy and getting their vision checked, while paying greater attention to fall risks during their patient assessments, and offering adequate fall prevention interventions.

Between 2011 and 2015, they found that 109,795 people over age 60 and living in nursing homes required emergency room care for face injuries. Half of the patients were over age 84 and 65 percent were women.

For each incident, the study team noted where on the face patients were hurt and how they sustained the injury.

The most common wounds were deep cuts or skin tears, which made up over 44 percent of all injuries. A similar proportion of patients experienced other soft-tissue injuries, including bruises on the skin or in deep tissues and the tearing off of patches of skin including eyelids or ears.

Bone fractures accounted for nearly 13 percent of injuries. More than two thirds of these breaks were to the nose, and the next most common fracture site was the eye socket.

The injuries were most often the result of falling and hitting structures like the floor, countertops, doors or cabinets, representing 57 percent of injuries.

Getting in and out of bed was the second most common source of injury, accounting for 23 percent.

“Falls are a tremendous source of disability in older adults,” said Hilaire Thompson, a professor at the University of Washington School of Nursing in Seattle.

“Older trauma patients are more likely to experience a longer hospital stay, increased number of complications, higher costs of care and a higher likelihood of dying for any specific injury than younger adults,” Thompson, who was not involved in the study, said by email.

“Facial injuries are underappreciated,” Thompson added, “as they may accompany other sometimes more severe injuries and are therefore overlooked.”

 

 

 

 

A North Carolina federal jury determined that a nursing home committed negligence that caused the deaths of three patients, with reckless disregard to their rights, and awarded their families $5.2 million in compensatory and punitive damages.

After a four-day trial, the jury determined that medical care given by nursing home Blue Ridge Health Care Center and management companies Care Virginia Management LLC and Care One LLC was grossly negligent, intentional or in reckless disregard of the rights of Del Ray Baird, Jacqueline Baird, and Elizabeth Jones.

Plaintiffs, administrators of the estates of deceased persons who were residents of North Carolina at the time of their deaths, and Samuel Kee, Sr., individually, filed the original complaint in Wake County Superior Court on December 23, 2013. On January 28, 2014, Plaintiffs filed an amended complaint. In the amended complaint plaintiffs bring state law claims for medical and/or professional negligence, ordinary corporate negligence, ordinary negligence, wrongful death, intentional and negligent infliction of emotional distress, breach of contract, and punitive damages.

These allegations stem from the treatment and deaths of three individuals while being cared for at the Blue Ridge Health Care Center (“BRHCC”) facility at 3830 Blue Ridge Road, Raleigh, NC 27612. Defendant Blue Ridge of Raleigh, LLC (“Blue Ridge”) is alleged to have held the license to operate the nursing home, BHRCC, where each of
the deaths occurred in this case.  See Order denying Motion to Dismiss..

The Waco Tribune reported that a jury found that Jeffrey Place Rehabilitation Center officials were negligent in their care of a blind, diabetic Waco man and compensated the man’s family $450,000 in actual damages. Homer Byrd, a 79-year-old retired tractor mechanic, died in November 2015, only a month after being admitted to Jeffrey Place.

Jurors deliberated about 7½ hours over two days before siding with Greg H. Byrd and his wife, Kim, in their wrongful death lawsuit against the Waco nursing center and its parent company, Senior Living Properties LLC.

Testimony from the five-day trial showed that Byrd, a diabetic on dialysis, developed an infected big toe that turned gangrenous, which led to Byrd’s right leg being amputated just above his knee and, ultimately, to his death.

Jeffrey Place staff breached the ordinary standard of care by failing to promptly discover and treat the infected toe. Nurses testified they noticed the toe, but not until the wound had turned black, had a foul odor and was 4 centimeters by 5 centimeters.

 

The awards include $100,000 for pain and mental anguish suffered by Homer Byrd before his death, $75,000 for Greg Byrd’s loss of his father’s companionship and love and $75,000 for Greg Byrd’s mental anguish over his father’s death. The jury awarded $200,000 in deterrent damages so this type of neglect doesn’t happen again.

 

“Due to the evidence we saw, it was just gross negligence,” juror Crocker said. “There was a lot more that could have been done for this man, and it was just absolute refusal to see a problem that is blatantly obvious.”

 

Michigan’s MLive reported that Kathryn Brackett, a dementia patient and resident of Crystal Springs Assisted Living Center was found dead in the early hours of Oct. 27 on the grounds outside the center. She died of hypothermia after being stranded outdoors for more than four hours in mid-30-degree temperatures and rainy conditions.

Yahira Zamora and Denise Filcek are the assisted living center employees facing felony charges which led to the October death of Brackett.

Zamora is accused of resetting an alarmed door designed to keep residents inside without checking whether any residents exited the facility. She faces a charge of second-degree vulnerable adult abuse — a felony punishable by up to four years in prison, or a fine of $5,000.

Filcek was responsible for making bed checks every 30 minutes and failed to check on patients despite falsely indicating she had on records. She faces a charge of intentional inclusion of misleading or inaccurate information in a medical chart — a felony with a maximum sentence of four years in prison, and/or a $5,000 fine.