U.S. News had an interesting article discussing how Louisiana‘s payments to private nursing homes for taking care of Medicaid patients have risen substantially over the last decade increasing profits even as their occupancy rates stayed flat, according to an audit.  The state Medicaid program spent $8.7 billion in federal and state dollars on nursing home care for people who are elderly or disabled from 2006 through 2016, as daily rates paid to about 260 nursing homes increased 54 percent from $112.34 to $172.82.  In the last budget year that ended June 30, Medicaid payments to the facilities reached $1 billion.  Occupancy rates over the same period, however, “have generally remained the same,” growing by less than 1 percent.

One easy explanation is that the nursing home industry is powerful and a hefty campaign contributor at the state capitol.  In fact, inadequate monitoring and enforcement caused the department to fail to recoup $3.2 million in Medicaid payments for ineligible patients in 2014.

 “Even with the increasing payments to nursing facilities, Louisiana continues to rank poorly in regards to quality of care,” auditors wrote.
 Auditors also said the Louisiana Department of Health needs to improve its oversight of payments to ensure they’re accurate. They said the agency should issue penalties for late cost reports from nursing homes and tougher sanctions for facilities that have repeat audit violations.

The L.A. Times reported the latest on the beneficial effects of ObamaCare.   A report – based on a state-by-state survey of data collected by the federal government – provides powerful new evidence that insurance gains made through the 2010 healthcare law are helping millions of patients get needed medical care.  Americans are no longer putting off doctor visits or struggling with medical bills, according to a new report examining the effect of the Affordable Care Act.

“The Affordable Care Act has put access to healthcare in reach for millions of Americans, particularly for people in states that embraced the law,” conclude the authors of the report, published by the nonprofit Commonwealth Fund.  Across the country, the law is credited with extending health coverage to more than 20 million previously uninsured Americans and dropping the nation’s uninsured rate to the lowest levels ever recorded.

An increasing number of studies have found similarly dramatic improvements in patients’ access to care after they get coverage.

“The fact is health insurance helps people get access to care, gets them better preventive care and more regular care for chronic medical conditions,” said Dr. Benjamin Sommers, a health policy researcher at Harvard who has extensively studied the effect of health insurance.

Between 2013 and 2016, the share of adults reporting that they delayed medical care because of concerns about cost declined in 45 states.

The percentage of adults at risk of being in poor health who had not been to the doctor in the previous two years declined in 37 states.

And the share of working-age adults with high out-of-pocket medical bills fell in 35 states between 2013-14 and 2015-16, according to the report, which is based on census data and national health surveys overseen by the Centers for Disease Control and Prevention.

These gains were particularly pronounced among low-income Americans, who have arguably benefited most from the 2010 law’s coverage expansion.

 

Politico reported that many insurers in the Affordable Care Act market are on pace to record profits this year for the first time, according to a POLITICO analysis of 31 regional Blue Cross Blue Shield plans, many of which dominate markets in their states.  The POLITICO analysis shows that insurers, on average, spent 78 percent of premium revenues on customers’ medical claims through the first nine months of this year.

“The political narrative is over a market in crisis, and that’s just not how the market actually looks right now,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, a nonpartisan research group. “At this moment, the individual insurance market looks quite stable and most insurers have achieved profitability.”

However, Trump’s reckless decision to cut off subsidy payments that insurers rely on to reduce the costs for low-income customers means plans will take a more than $1 billion financial hit, according to the National Association of Insurance Commissioners.

The Buzz had a peculiar story about Rick Scott’s attempt to hide and cover-up the neglect and abuse in Florida’s nursing homes.  Recently, with no announcement or notice, AHCA wiped its website clean of all nursing home inspections, shielding the industry to the detriment of consumers.

For many years, Florida’s Agency for Health Care Administration’s website included links to inspections of nursing homes, retirement homes and hospitals. They were available with a few keystrokes with very few redactions. The agency then began to heavily redact the reports — eliminating words such as “room” and “CPR” and “bruises” and “pain” — and rendering the inspections difficult to interpret for families trying to gauge whether a facility is suitable for a loved one.  AHCA says the redactions were necessary to protect medical privacy, though patients were identified only by number.

In the past year, the state spent $22,000 for redaction software that automatically blacks out words the agency says must be shielded from the public. Those same words were available on a federal website unredacted. Elder and open-government advocates said the newly censored detail did more to protect the homes than patients.

 

 

 

Newsweek reported that enrollment for health insurance under ObamaCare is healthy with less than a month to go in the current sign-up period, according to the Centers for Medicare & Medicaid Services, a federal agency.  That brings the total number of enrollees in this period to 2.3 million, which is almost 900,000 people — or 64 percent — more than the number of customers who signed up during the first four weeks of enrollment in 2016, according to CNBC.  The figures included more than 566,000 new consumers and 1.7 million renewals, with total Healthcare.gov users exceeding 8.1 million.

The current enrollment period ends December 15.  Americans have much less time to sign up than in the past.  The Trump administration is deliberately making the HealthCare.gov portal unavailable at key times to discourage participation.

The Sun Sentinel had a great article on new reforms to increase safety in Florida nursing homes.  A dozen bills to reform nursing homes are under consideration in the Florida Legislature after 14 people died at a Hollywood, Florida, nursing home that lost power during Hurricane Irma.  Many of the bills require nursing homes and assisted living facilities to have generators capable of powering air conditioning in the event of a power loss.

The latest give new teeth to Florida’s Long-Term Care Ombudsman program, which records show has regularly turned up fewer complaints each year under Gov. Rick Scott.  The Ombudsman program, which is supposed to look out for residents in Florida’s 683 nursing homes and thousands of assisted living facilities, would be allowed to conduct undercover operations inside nursing homes, posing as patients or employees, to look for abuse and neglect.

The big boost to the state Ombudsman program is unique among the many bills. Another novel portion requires facilities to allow residents’ families to monitor them electronically as a safeguard against abuse.

The multitude of other bills includes:

SB 284: Filed by state Sen. Lauren Book, D-Plantation, this bill requires nursing homes and assisted living facilities to have generators that can power air conditioning in the event of a loss of power, and requires the Agency for Health Care Administration to conduct an unannounced inspection at least every 15 months to check and make sure the generator is in working order. The bill requires facilities to have enough fuel to power generators for five days.

HB 479: Filed by state Rep. Patricia Williams, D-Lauderdale Lakes, this bill requires an unannounced inspection by AHCA every four months. It also requires nursing homes and assisted living facilities to have generators to power air conditioning and enough fuel to last for five days.

HB 327: Filed by state Rep. David Richardson, D-Miami Beach, this bill requires AHCA to carry out an announced inspection each May before hurricane season and requires facilities to have generators that can power air conditioning and enough fuel to last four days.

SB 372: Filed by state Sen. Rene Garcia, R-Hialeah, this bill would require generators to power air conditioning and enough fuel for four days. It also requires AHCA to carry out an announced inspection in May before the start of hurricane season. Additionally, it requires the Public Service Commission to ensure that utility companies treat nursing homes and assisted living facilities with at least 50 residents that offer critical medical care as high priorities, similar to hospitals.

HB 443: Filed by state Rep. Emily Slosberg, D-Boca Raton, requires nursing homes and assisted living facilities to have current contact information on file with both residents and the state Long-Term Care Ombudsman. It also mandates that residents be allowed to access personal records on file at the facility.

SB 830: Filed by Farmer, this bill is identical to HB 443.

SB 558: Filed by state Sen. Daphne Campbell, D-Miami, this bill requires all health care facilities that provide overnight care — including nursing homes and assisted living facilities — to have generators that can power air conditioning and enough fuel for four days. The generators must be able to maintain conditions throughout an entire facility.

HB 435: Filed by state Rep. Larry Lee, D-Port St. Lucie, this bill establishes a matching grant program, funded with $5 million every year through 2023, so that facilities buying generators can get a dollar-for-dollar matching grant from the state on a first-come, first-serve basis. The grant is open to both public and private facilities.

HB 437: Filed by Lee as well, this bill requires facilities to have generators and enough fuel for seven days.

HB 331: Filed by Slosberg, this bill adds new language to the state’s patients bill of rights, requiring facilities to send an explanation for any relocation in writing to both a resident and the Long-Term Care Ombudsman.

 

Ed Kilgore at New York Magazine explains how repealing the Obamacare health-insurance-purchasing mandate, which the president wants, and which is currently part of the Senate tax-cut bill, will effect rural voters of Trump.   A revised Congressional Budget Office estimate shows as many as 13 million people could lose health insurance over ten years, with individual premiums going up about 10 percent a year — a price Senate Republicans appear ready for other people to pay in exchange for $338 billion to devote to tax cuts for corporations and the wealthy.

Now we have some new analysis from the Los Angeles Times on how the mandate repeal might affect specific parts of the country. And it’s bad news for the rural people of Trump Country.

There are 454 counties nationwide with only one health insurer on the marketplace in 2018 and where the cheapest plan available to a 40-year-old consumer costs at least $500 a month. Markets in these places risk collapsing if Congress scraps the individual insurance mandate.

Eighty-six percent of these 454 at-risk counties have fewer than 50,000 residents, census data show. Healthcare costs are often higher in rural areas, as there are fewer medical providers and populations tend to be older and sicker.

These counties also overwhelmingly supported Donald Trump last year, with 9 out of 10 backing the Republican presidential ticket, according to election data.

In addition to Alaska, Iowa, Missouri, Nebraska, Nevada and Wyoming, the counties are clustered in southwestern Arizona, western Colorado, southern Mississippi, central North Carolina, as well as parts of Georgia, Virginia and West Virginia.

Many of the people affected by this measure probably don’t much like the idea of being told they have to buy health insurance. But they’ll like having no real access to health insurance even less.

U.S. News reported that fire sprinklers inside a southeastern Idaho nursing home did not activate when a blaze erupted last weekend.  All of the 49 patients were evacuated and several were treated for smoke inhalation.  The fire likely started in the attic of the facility and was possibly sparked by a malfunctioning light fixture, authorities said.  The State Fire Marshal’s Office and the Pocatello Fire Department are investigating the cause of the fire that destroyed the Safe Haven Care Center, the Idaho State Journal reported .

The facility was equipped with sprinklers but none activated during the blaze. “We are investigating why the fire suppression system didn’t operate as expected,” Smith said. “There is a question of whether or not the fire suppression system was turned on, and there are also some questions about whether or not the fire suppression system had some parts of it that were abandoned.”

 Department of Health and Welfare officials inspected the sprinkler system in August 2016, finding the facility did not maintain the system in reliable operating condition.

The 11Alive Investigators have uncovered new information about the Atlanta nursing home, owned and operated by the chain SavaSeniorCare, accused of not responding fast enough to save a dying veteran.  11Alive introduced you to James Dempsey caught on hidden camera begging Sava’s nursing home staff for help before dying in 2014.

The 11Alive Investigators discovered a former employee claims she and others complained about staffing shortages for years before and after Dempsey’s death at the facility. The claims were made in a 2015 deposition from Mable Turman, a CNA, or certified nursing assistant, who is seen in the hidden camera video inside Dempsey’s nursing home room while is gasps for air.

Turman made those claims during a deposition with Mike Prieto, an Atlanta attorney representing the Dempsey family.

Prieto: “Did you personally make a request for an additional CNA on the Alzheimer’s ward on the night shift?”
Turman: “Me and the other CNA constantly have.”
Prieto: “Do you feel like the facility is understaffed?”
Turnman: “Now? Yes.”

The hidden camera video shows Dempsey pressing his call light for help numerous times. At one point, it took nursing staff eight minutes to respond.  In the video deposition, Turman did not seem surprised with the delayed response.

“I’m gonna be honest, I don’t think they have enough staff in order for me to get to that call light on a prompt basis because we have been asking for an extra CNA at night,” said Turman in the deposition.

After the deposition, documents show the nursing home continued to experience staffing issues.  According to a 2016 Medicare inspection report, an investigator identified “inconsistent staffing.”

11Alive requested an interview with Sava Senior Care, the owner of the nursing home. The operator did not provide a response.

Research proves higher staffing ratios improves care and provides better patient outcomes. According to a 2016 study published in the U.S. National Library of Medicine’s National Institute of Health, “nurse staffing levels are too low in half of U.S. nursing homes.”

The study identified research that showed “numerous studies have consistently shown that higher state minimum staffing have had significant positive effects on staffing levels and quality outcomes.

Federal law requires nursing homes to have “sufficient staff to meet the needs of residents and one registered nurse (RN) Director of Nursing on duty for eight hours a day, seven days a week and licensed nursing in evening and night shifts.”

 

Medscape published an article from Margaret R. Nolan, DNP, GNP about taking away nursing home residents’ right to sue for abuse and neglect.  Margaret R. Nolan. Nursing Home Residents: No Right to Sue for Unsafe Care, and It’s Wrong – Medscape – Nov 14, 2017.

Litigation or Arbitration When Nursing Home Care Is Unsafe?

The Centers for Medicare & Medicaid Services, under the new administration, has announced changes to nursing home residents’ and families’ ability to sue for episodes of substandard care. Under this new plan, incoming residents and their families will sign away the right to litigate upon admission and, instead, agree to solve disputes through arbitration rather than through the courts.

Unsafe levels of care in nursing homes are, unfortunately, common. The federal government attempts to provide close oversight of nursing homes; but, in spite of being placed on a strict oversight status, in many states, hundreds of nursing homes still provide unsafe care to patients. The courts are viewed as a fail-safe option for patients’ protection. Litigation is often the only means to force nursing homes to provide standard, safe care.

The new administration is supporting arbitration settlements alone for wrongful care of residents. Many consumer groups and attorneys general strongly oppose this plan and believe that litigation is an effective way to ensure that nursing homes deliver appropriate care to vulnerable residents.

 Viewpoint

The elderly residents of nursing homes or long-term care are highly vulnerable to abuse. The Obama administration attempted to make it easier for nursing home residents to litigate for suspected negligence or abuse, but the bill never became law. A particular concern was that the promise to arbitrate was often buried in nursing home admission documents so that families were often unaware of this option. Under the Trump administration, nursing home residents will continue to sign arbitration agreements instead of having the option of suing. If new residents refuse, they could be denied admission to the facility. The Trump administration has asked for more understandable language for incoming nursing home residents so that they can better understand what they are signing, but opponents argue that without choice, it’s still mandatory for the incoming resident to sign.

On a larger scale, the current administration is trying to cap medical malpractice claims and shorten the statute of limitation to 3 years. Many fear that this will also lead to more deaths and injuries and weaken safety for patients, especially those who reside in nursing homes.

This is a critical time for nursing leaders to speak up about geriatric care, safety, and abuse. Nurses need to help educate our leaders to make good decisions that will protect vulnerable residents in nursing homes.”