ABC Action News reported the controversy surrounding a nursing home’s refusal to provide certain medicine to one of their residents. Zephyrhills Health and Rehab Center, which is operated by Adventist Health System, refuses to allow Charlotte Simpson pain relief by refusing to allow her to have the medical marijuana she has a legal prescription to take.  Simpson is confined to a wheelchair and suffers Parkinson’s Disease, arthritis and other ailments.

“You should see the condition she’s in. It’s horrible,” said Bert Greene, describing his mother Charlotte Simpson. “She’s got uncontrollably shaking, excruciating pain.”

Greene said after medical marijuana became legal in Florida, a doctor prescribed it for his mother and she applied for a compassionate use permit.

“When she was finally approved, and the medicine was delivered, they gave it to me and told me I had to take it home with me,” Greene said.

 

 

New York Magazine reported that health care premiums will increase significantly in 2018 because of Trump’s sabotage of the Affordable Care Act.  This week, health insurance plans across the country submitted their final rates for 2018, many requesting massive double-digit rate hikes and explicitly citing uncertainty around Congress and the president’s plans for the individual market.

“Right now, 2018 premiums for individual health policies under Obamacare are being decided by insurance companies without any certainty about one of the basic elements of the program: reimbursements to offset “cost sharing reductions” they are required to make to keep low-income consumers from bearing the brunt of high co-payments and deductibles. These reimbursements are currently stuck in limbo, as Trump refuses to promise to keep making them and bipartisan Senate negotiations to take the decision out of the president’s hands and authorize them legislatively crawl toward an uncertain conclusion.”

“In interviews with major publications, Donald Trump repeatedly threatened to destabilize the Affordable Care Act marketplaces — by abruptly halting subsidies to insurers — as a means of eroding popular support for the law. Meanwhile, his Health Department spread doubt about whether it would enforce the tax penalty for refusing to sign up for insurance; cut funding for the law’s outreach groups; slashed Obamacare’s advertising budget by 90 percent; spent a portion of the remaining ad budget on propaganda calling for the law’s repeal; cut the open-enrollment period by 45 days; and announced that it would be taking Healthcare.gov (where people can enroll in Obamacare online) offline for nearly every Sunday during that time period, for “maintenance” purposes.”

BuzzFeed News revealed that the Trump administration had instructed the Health Department’s ten regional directors not to participate in state-based events promoting ACA enrollment, as they had for each of the past three years.

All available polling suggests that most voters now trust Democrats more than Republicans on the issue of health care — and believe that Trump is responsible for any problems with Obamacare, going forward.

King Trump has issued Executive Orders to create loopholes that will destroy the individual markets for health insurance.  Trump has been threatening to destroy the Affordable Care Act by executive order after the Republican Congress failed to repeal ObamaCare.  The basic idea appears to be an expansion of the kinds of entities who can take advantage of so-called “association health plans” — group insurance plans normally available to trade associations and other groups of business people — and then a reclassification of these plans so that they do not have to comply with Obamacare regulations. It’s sort of a Great Escape from Obamacare for small businesses and perhaps even individuals. The idea would mostly attract younger and healthier consumers seeking cheaper and skimpier health plans, leaving older, sicker, and therefore more expensive people to sink the remaining Obamacare exchanges with their costly problems.

The across-state-lines aspect of this plan — a big deal in the pre-Obamacare days when there were few if any national standards for health insurance — would not be nearly as significant as the exemption from Obamacare’s essential health benefits and preexisting-conditions requirements.

The idea of expanding and deregulating association health plans as a stand-alone initiative is especially dangerous when pursued separately from other conservative health-reform ideas that might help counteract some of its effects, such as subsidies for high-risk pools for “left behind” people with preexisting conditions, or more money for states to come up with their own ways of managing risk.

Health-policy wonk Tim Jost said of the proposed executive order that it would “destroy the small-group market …. We’ll be back to where we were before the Affordable Care Act.”

Loophole No. 1: Expanded Association Health Plans

Before Obamacare, associations were free to model their national plans around the regulatory requirements of any individual state. The Affordable Care Act put an end to this state of affairs, by subjecting association health plans to the same essential health-benefit requirements as individual small businesses.

Trump’s executive order calls on the secretary of Labor to expand the use of association health plans by making it easier for associations to form across state lines, and to band together for the exclusive purpose of purchasing health insurance.

This could allow new association health plans to grow so big, they qualify as large employers — and Obamacare does not require large employers to offer plans that cover essential health benefits. This would allow younger, healthier small businesses to exit the small-group market, thereby increasing premiums for the older, sicker businesses which are left behind.

And the Trump administration is reportedly considering an even more radical change, one that could effectively end Obamacare as we’ve known it. According to Vox, the White House may try to allow individuals to buy into cheap, skimpy association health plans. This could set off a death spiral in the individual market as healthy people flee for cheap association plans, thereby leading insurers to raise premiums (to defray the cost of covering an increasingly sick pool of enrollees), thereby leading even more healthy people to flee for cheap association plans, thereby leading insurers to raise premiums, etc., etc. …

Loophole No. 2: Lengthened duration of short-term insurance
Short-term health insurance policies are free from Obamacare’s regulatory requirements. They offer few services, and are designed for people during a temporary period of unemployment.  Before the Affordable Care Act, Americans could remain on short-term health insurance for up to a year. But to prevent healthy people from using the plans to avoid subsidizing the sick on the individual market, the Obama administration brought that limit down to three months.

Trump’s order calls for expanding access to short-term plans by reversing this rule. Once again, the effect would be to bleed healthy enrollees from the Obamacare exchanges. The effect, once again, would be to engineer a destabilizing increase in premiums for those in the individual market.

Dove Press had clinical guidelines on prescribing psychotropic medication for nursing home residents with dementia on their website.

Objective: The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs) to nursing home residents with dementia.

Subjects and methods: GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from south-eastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs’ opinions.

Results: A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141), and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126).

Conclusion: According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities.

The Telegram reported the Aug. 7 death and cover-up of Walter E. Haddad.  State and federal agencies investigated the suspsicious circumstances surrounding the death of Haddad who died after he fell and hit his head, and nursing home staff covered up the fall rather than send him to the hospital.

The report said that after hearing a loud thud about midnight on Aug. 6, a certified nurse assistant and a licensed practical nurse found Mr. Haddad lying on the floor and they put him back in his bed.  No assessment by a registered nurse was done. The CNA told investigators that he did not report the fall, as required by the facility, because the LPN had asked him not to.

“However, staff did not complete a thorough clinical evaluation or neurological assessment on (Mr. Haddad), which resulted in a delay of transfer to the hospital for evaluation of possible injury,” investigators said in the report.

Mr. Haddad’s daughter, Lorna Haddad, took issue with the report. She said staff should have been more careful because they knew that her father, who helped found the nursing home, had a history of falls. The retired accountant had moved into the nursing home last year, after Parkinson’s disease left him prone to falls. She said notification of his fall risk was posted throughout his area of the facility.

“I think the report is meaningless,” she said. “The fact that he didn’t have an alarmed bed or an alarmed chair is alarming.”

The report in general said professional standards of quality were not met because of the actions or inactions of the staff.  Every time a patient falls, injury or not, they’re required to call the physician and the patient’s family.

The morning after he fell, Mr. Haddad told several staff about the incident. The only thing that they did was to give him Tylenol. When Mr. Haddad’s family came to visit, he told them that he had fallen the night before and hit his head. Staff told the family that there was no report of a fall and that Mr. Haddad may have been mistaken or confused. When his speech became slurred and he complained of neck pain, he was taken to the trauma unit at UMass Memorial Medical Center, where he died.

The Santa Fe New Mexican reported that Casa Real nursing home in Santa Fe owned and operated by Preferred Care Partners Management Group has at least temporarily improved persistent quality-of-care problems enough to resume billing Medicare and Medicaid for newly admitted residents.  Casa Real is one of only two homes in Santa Fe that accept Medicare and Medicaid patients.

For more than two months, Casa Real had been barred from charging Medicare or Medicaid for new residents after the Centers for Medicare and Medicaid Services found the nursing home wasn’t in compliance with federal care standards.

Inspections this year turned up a long list of problems, including medication errors, expired food and drugs on shelves, unreported resident injuries and assault, poor care of bed sores, nursing understaffing and inadequate safeguards against the spread of dangerous infections.

The former director of nursing at Casa Real from May to August has accused management of forging patient records in an attempt to show the facility was in compliance with care standards dealing with monitoring of medication effects on residents.  Of course, she was soon fired.

The August inspection found residents weren’t receiving medications as directed by their physicians and that the nursing home wasn’t doing enough to ensure that residents didn’t receive unnecessary drugs, including psychotropic medications.

The federal agency in May designated Casa Real as a “special focus facility” because of its poor record of complying with care standards, and it said the nursing home would be subject to more frequent inspections. The designation is given to the nation’s poorest-performing nursing homes and is meant to address the “yo-yo” problem of facilities routinely falling in and out of compliance with care standards.

The state Attorney General’s Office is suing Preferred Care, alleging it has defrauded Medicaid by having insufficient staff to meet the needs of residents at its Santa Fe nursing homes, as well as its facilities in five other New Mexico communities. Preferred Care has denied the allegations.

The Hill had an article on the False Claims Act.  The FCA authorizes private individuals to sue anyone they think is defrauding the federal government. Individuals filed more than 4,700 FCA actions between 2009 and June 2016. The Act provides for treble damages. The spoils are divided among the person alleging the fraud, his attorneys, and the federal government. In 2014, the Department of Justice reported that FCA “recoveries” totaled $5.79 billion. Health care lawsuits accounted for $2.3 billion of that.

The federal government must investigate the claims in every FCA case. The initial investigation is done under seal. Defendants may be investigated for years, but not know about it until their business documents are subpoenaed. The individual alleging fraud can proceed with a case even if the government decides against it.

Increasingly sophisticated groups of attorneys choose to continue. They sue any entity that receives federal payments, claiming that the failure to comply with administrative standards constitutes fraud. At the time the act was passed, the goal was to prosecute fraud cases in which a contractor billed the United States for nonexistent or worthless goods or services.

 

Vox reported on Trump’s continued attempts to sabotage the Affordable Care Act.  Trump has drafted an executive order that would exempt many association health plans, groups of small businesses that pool together to buy health insurance, from core requirements like the coverage of certain essential health benefits.

An association health plan, as Vox’s Sarah Kliff has previously explained, is a way for a group of small businesses pool together to buy insurance, giving them more purchasing power and access to cheaper premiums.

It would potentially allow individuals to join these plans too, which would put individual insurance marketplaces in serious peril by drawing younger and healthier people away from them.  President Trump seems ready to destabilize the market for customers who are left behind with higher premiums and fewer insurers.

Essential health benefits, mandating that insurers cover everything from hospital care to prescription drugs to maternity care, prevent plans from crafting their coverage to attract mostly young and healthy customers at the expense of older and sicker people, which had been one of the primary problems with the association health plan model before the law.

 

KOCO reported that as many as half of Oklahoma’s nursing homes could be forced to shut their doors by Dec. 1, according to the Oklahoma Association of Health Care Providers.  The state’s health care authority announced a 9 percent cut from Medicaid to offset the money lost after the cigarette tax fee was ruled unconstitutional.

According to the OAHCP, a 9 percent cut means 18 counties would not long have a nursing home. Statewide, 11,000 people would be displaced, many with nowhere to go.  Nursing homes rely on Medicaid and say a 9 percent cut would have a devastating impact.

 

 

Go Upstate reported that Cherokee County will be the home of a state-run veterans nursing home but state funding has not been confirmed.  Because the facility will be owned by the state, the $41 million needed for construction will come from the state budget.

Cherokee County County Council purchased a 60-acre parcel of land from the Batts family for $463,000.  The county is now in the final stages of transferring the land to the state so that the development process can begin.

“The commitment from the state was that this would be one of the sites they would build on as soon as they were funded,” he said. “We have an eight-year reversal of the land, which means the state has eight years to construct the facility. If they don’t, the land will come back to the county.”

Currently, South Carolina has three state veterans nursing home facilities — E. Roy Stone Veterans Pavilion in Columbia, Veterans’ Victory House in Walterboro and Richard Michael Campbell Veterans Nursing Home in Anderson.

Humphries said with the number of veterans in South Carolina closing in on one million, three facilities are simply not enough. Humphries said veterans and their families are driving 100 miles or more to access existing facilities.

“The bed wait for a state veteran’s nursing home in this state, today, is about six months,” he said. “That’s a big red flag when we have a population of more than 800,000 veterans.”

 In addition to the Cherokee County facility, others are planned in Florence County and Columbia, Humphries said.

Each nursing home will have 108 beds, and Humpries said having one in Cherokee County will provide better access for veterans within the county and those in surrounding counties like Spartanburg, York and Chester.