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.

 

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 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.”

 

Commons Dreams had an article expressing disbelief with Trump’s plan to force nursing home residents into arbitration instead of protecting their constitutional right to a jury trial.

Rep. Ted Lieu asked “Why does Trump hate grandmothers?” as he decried a proposal from the administration that would prevent abused or mistreated seniors in nursing homes from getting their day in court, jeopardizing their health and safety.

Fellow lawmakers as well as patient and consumer advocacy groups like Public Citizen, said the effort to roll back protections from some of society’s most vulnerable people is just part of “a disturbing trend of the Trump administration attempting to reverse critical protections against forced arbitration,” which prevents individuals or groups of people from filing lawsuits or seeking damages for fraud, abuse, neglect, medical malpractice and other forms of wrongdoing.

“Forced arbitration clauses in nursing home agreements stack the deck against residents and their families who face a wide range of potential harms, including physical abuse and neglect, sexual assault, and even wrongful death at the hands of those working in and managing long-term care facilities,” the letter (pdf) states. “These clauses prevent many of our country’s most vulnerable individuals from seeking justice in a court of law, and instead funnel all types of legal claims, no matter how egregious, into a privatized dispute resolution system that is often biased toward the nursing home. As a result, victims and their families are frequently denied any accountability for clear instances of wrongdoing.

Lauren Saunders, associate director of the National Consumer Law Center, said “Everyone should be outraged that the Administration is proposing to strip legal rights from fragile seniors and their families during the incredibly stressful time when a loved one is entering a nursing home.”

Benziga had an article about the National Academy of Elder Law Attorneys (NAELA) submitted a NAELA letter to CMS urging the agency to withdraw its new proposal to allow forced arbitration provisions in nursing home admission contracts to prohibit a trial by jury.  Established in 1987, NAELA is a non-profit association that assists lawyers, bar organizations, and others. The mission of NAELA is to establish NAELA members as the premier providers of legal advocacy, guidance, and services to enhance the lives of people with special needs and people as they age.

“It’s very disheartening to see CMS’s about-face. The truth is individuals who need nursing home care are often under extreme duress to get admitted and cannot imagine they will be subject to the opposite: physical violence, sexual abuse, or extreme neglect when they arrive,” said NAELAPresident Hyman G. Darling, CELA, CAP.

According to the letter, “if CMS cannot elucidate a precise reason as to why residents would now be better off giving up their rights before they might fully realize what they have lost, it cannot categorize this reversal as an improvement over anything.”

Forbes had an article criticizing the Trump’s Administration decision to allow nursing homes to restrict resident’s constitutional right to a jury trial.

When your loved one needs nursing home care but the facility requires you to sign a mandatory arbitration agreement that states you will not sue, even if your loved one gets mistreated, neglected or abused. If you sign the agreement, your only option may be “third party arbitration”. If you don’t sign, you may not be able to get your loved one into the right nursing home. What will you do?

President Barack Obama signed a Centers for Medicare and Medicaid Services (CMS) rule to help prevent such a scenario from happening. Obama’s rule would prevent any nursing home that receives Medicare or Medicaid funds (which is a lot of them) from enforcing such “no sue” agreements. But now this rule was overturned by President Donald Trump’s administration.

The conditions and quality of care at nursing homes are extremely variable, ranging from good to appalling. A study conducted by researchers from UCSF (Charlene Harrington,Helen Carrillo, and Taewoon Kang) and the University of California-Irvine (Brian Olney) published in Health Services Research  found a number of staffing and quality of care deficiencies in many for-profit nursing homes.

According to the Centers for Disease Control and Prevention (CDC), each year 1 to 3 million serious infections occur in long-term care facilities with as many as 380,000 people dying as a result.

As the U.S. News and World Report described, a study published in the American Journal of Infection Control showed that about 15 percent of U.S. nursing homes were cited for lack of adequate infection control procedures.

As David Ruppe reported previously for ABC News, a Congressional study found that from January 1999 to January 2001, 30 percent of U.S. nursing homes had a total of nearly 9,000 cited instances of abuse with 1,601 cases causing harm or putting residents at risk for serious injury or death. And such abuse is not just out of neglect. Nursing home staff have assaulted and even sexually assaulted nursing home residents, as detailed in a story by Blake Ellis and Melanie Hicken for CNN .

Over 75 consumer groups have banded together to oppose changes to Obama’s rule. The Fair Arbitration Now (FAN) Coalition argued on their web site that retaining the right to sue is important protection for consumers:

Most people don’t know that forced arbitration clauses are buried in the fine print of many contracts to receive products and services, and even to obtain employment. These contract clauses force people to give up their right to go to court – even if a company harms them or rips them off. Instead consumers are pushed into secret arbitration. In arbitration there is no judge, jury, and decisions are rarely appealable. Arbitrators do not have to follow the law. Civil rights and consumer protection laws can become meaningless in arbitration. That’s why we need a federal law to make arbitration truly voluntary. Eliminating forced arbitration clauses from contracts will give us – consumers and employees – the power to choose court or arbitration after the dispute arises.

 

The New York Times had an article explaining how the Problem Solvers Caucus is trying to fix ObamaCare.  This is not the time for more partisan fighting.

“Our proposal first focuses on the most urgent crisis: the skyrocketing cost of individual health insurance premiums. The Trump administration is considering suspending cost-sharing payments that defray out-of-pocket payments like deductibles and co-payments for people earning less than 250 percent of the poverty line. Because of uncertainty about this subsidy, insurers have said premiums could rise by 15 percent or more. On Aug. 16, insurers must submit their 2018 rates to state regulators for approval; many may be forced to leave the individual marketplace altogether.”  This plan will stabilize markets by making the cost-sharing payments mandatory and prevent rates from rising sharply.

“Second, we provide a relief valve to help states deal with the high cost of pre-existing and chronic conditions. The costliest 5 percent of patients account for nearly half of all health care spending in the country. We propose a dedicated stability fund — essentially a form of reinsurance — that states could use to reduce premiums and limit losses for providing coverage for these high-cost patients.”

“Third, our proposal provides relief to certain businesses from the mandate that they provide insurance to full-time employees. It also defines “full time” as a 40-hour workweek to discourage businesses from manipulating employees’ weekly hours to skirt the mandate. More than 90 percent of large businesses offered health care before the Affordable Care Act, and studies show that they would continue to do so under this change; others would move to find employee coverage in the individual marketplace.”

Fourth, the plan eliminates the Medical Device Tax, an excise charge of 2.3 percent. And finally, we provide states with additional flexibility to enter into agreements — such as enabling the sale of insurance across state lines — that would provide more choice and lower costs.

This proposal would not increase the federal deficit, offering several options to offset the new spending.

Forbes had an article on a company called EarlySense.

“One company, EarlySense, is bringing skilled nursing facilities into the digital age through a practical and inexpensive approach. For several years, its contact-free patient monitoring systems have been used by hospitals to continuously track respiratory rate, heart rate and movement. The technology is a direct response to the challenges hospitals face in monitoring non-critical (non-ICU) patients—tracking their care status and preventing costly falls and pressure ulcers. With monitor bells ringing frequently, over time, nurses can develop alarm fatigue. Standard bedside equipment becomes the “machine that cried wolf”—making nurses less likely to respond to alarms they hear all day. This is exactly where continuous monitoring steps in.”

“Real-time alerts show 43% fewer patient falls, 64% fewer pressure ulcers and 86% fewer code blue events. A statistical analysis estimated that institutions using EarlySense leveraged the data and far-less-frequent alerts to save more than 550 lives, 800 falls and more than 45,000 hospitalization days in 2016.”

The key takeaway: improved care and reduced costs.

EarlySense technology is also user-friendly. Nurses can view the data at the bedside, nursing station or on a tablet, and receive alerts in real time.