The Centers for Medicare & Medicaid Services recently rejected a proposal from Kansas to place a three-year lifetime cap on some adult Medicaid enrollees. Arizona, Utah, Maine and Wisconsin have also requested lifetime limits on Medicaid.  Since Medicaid began in 1965, no state has restricted how long beneficiaries could remain in the entitlement program.

 This was the first time the Trump administration has rejected a state’s Medicaid waiver request regarding who is eligible for the program.  CMS has approved work requirements for adults in four states —New Hampshire, Kentucky, Indiana and Arkansas.

All these states expanded Medicaid under the Affordable Care Act to cover everyone with incomes of more than 138% of the federal poverty level ($16,753 for an individual). The work requirements would apply only to adults added through that ACA expansion.

 

A scabies outbreak at Longmeadow Nursing Care nursing home in south Arkansas spread throughout the facility and into the community after those in charge failed to act. According to a government report, management told nursing staff in some cases not to leave any documentation indicating they were treating residents for scabies, the Arkansas Democrat-Gazette reported. Residents with scabies weren’t isolated and proper procedures were neglected, causing employees to contract the bugs that spread outside the facility.  Scabies is a highly contagious skin condition caused by mites, according to the U.S. Library of Medicine.  The facility neglected to treat staff members who developed scabies, which eventually spread to their relatives, according to the report.

State regulators cited the facility in July for failing to properly address a smaller infestation affecting a few residents, just weeks before the condition struck every resident at Longmeadow. A nurse told inspectors the facility didn’t document the outbreak because of instructions from higher authorities.  The state Office of Long Term Care gave the violations the most severe rating.

Kelly Holland said her husband, Ralph, suffered from the scabies infestation.

“You could see where he had clawed them, trying to get to the itch,” said Holland.

She says the nursing staff tried to convince her that the itching was not caused by scabies.

“They kept saying ‘Oh it’s a side effect from one of your medications,’ … that was a lie … the whole thing was a lie,” said Holland.

“It was just torture for both me and for him,” said Holland.

Even though the facility has a way to track outbreaks like scabies, a worker told state inspectors higher’s up “Didn’t want us to document the residents had scabies on any of the paperwork, but that’s what we were treating them for.”

State records reveal that in some cases, nursing staff said they were told not to leave a paper trail and did not record whether its 28 residents received a topical cream prescribed by a physician during the December outbreak.

 

 

Slate had an interesting article discussing how and why the uninsured rate has gone up after Trump’s sabotage of ObamaCare.  But there’s an odd political caveat: At the moment, the uninsured rate only seems to be rising for Republicans.

The share of working-age adults without health insurance has increased for the second year in a row, according to a new report by the Commonwealth Fund. In the group’s latest annual tracking poll, 15.5 percent of Americans between 19 and 64 said they lacked coverage, up from 14 percent last year and 12.7 percent during President Obama’s final lap in office, when the uninsured numbers hit a historic low.

The Commonwealth Fund isn’t the only organization to find a drop in health coverage. Gallup’s last tracking poll found that the uninsured rate had risen 1.7 percentage points since the end of 2016. To some extent, that’s not surprising. The White House’s attempts to undermine Obamacare have driven up the sticker price of health plans sold on the individual market, which has surely led some people to drop their coverage. What’s somewhat more puzzling is that both Gallup and Commonwealth find that the biggest drops in coverage have occurred among lower-income households, who typically qualify for subsidies under the current health law. Commonwealth found that the entire decrease in coverage last year occurred among households making less than 250 percent of the poverty line.

Rising uninsured rate
Commonwealth Fund

That’s a bit odd because, for the most part, lower-income families should not have seen the cost of their insurance go up much, if at all, since the Affordable Care Act caps their premiums at a percentage of their income. In fact, the cost of insurance ended up dropping for many subsidized insurance customers this year, because of how states reacted after Donald Trump cut off certain payments to insurers. And while it’s true that Republicans repealed the individual mandate as part of their tax law, that change doesn’t take effect until 2019. At the moment, Americans are still required to buy coverage as before.

 One of the most puzzling findings in the Commonwealth Fund report is that, last year, the uninsured rate only increased among Republicans. That’s surprising, since even in deep red states that didn’t expand Medicaid, many low-income minority communities where people are at risk of falling into Obamacare’s coverage gap tend to vote Democrat. And yet, Commonwealth found no statistically significant change in the uninsured rate among Democrats or independents; among Republicans it rose 4 percentage points.

Uninsured rate by party
Commonwealth Fund

Forbes had an article about the difficulty of relying on nursing homes to take care of our loved ones.  “When your loved one is admitted to a nursing facility, you are at their mercy. There is a significant imbalance of power in many ways and many families may find themselves feeling completely lost.”

We expect that the people with the most experience will hold our hands and help us through this difficult period, however, this is not always the case. Unfortunately, the situation for seniors continues to deteriorate and, as family members try to grapple with mounting issues it can take a toll on their relationships.

Poor Organization

One of the first things you should determine is whether there is a clear chain of command at the nursing home. Immediately find out who you should contact with all of your questions. If they rattle off different names in different departments, INSIST that you work with ONE person to avoid confusion. 

Not only are there a lot of moving parts in nursing homes but there may be a high turnover rate among employees. Who you spoke to yesterday may be gone tomorrow. As such, try to maintain contact with the highest level staff member and know who you need to go to as a backup.

Misinformation

In workplaces where employees come and go, you may notice that a lot of people are confused about their own roles. Whether the staff members are new, poorly trained or even disinterested in their job, this is problematic because you are relying on these people for information.

To combat this issue, again, try to discuss things with one person and document every single interaction. To make this easier, consider making email your primary mode of contact. You will have a written record of everything that has been said which may come in handy if a dispute ever arises (and it probably will).

Staffing Issues

Not to sound like a broken record but nursing homes really do struggle to keep employees, especially the good ones. You may quickly discover how much this affects the quality of care at many different levels.

From poorly maintained rooms to poorly maintained records, an understaffed senior residence can be a dangerous place but there may be little that you can do. Sadly, this isn’t an uncommon issue and seniors could be left feeling neglected. Be friendly with the staff and show them you are invested. This will send the message that you are kind but also vigilant.

Medical Malpractice

In the worst-case scenario, a nursing home resident can be physically or mentally harmed by negligent medical care. This, unfortunately, can have permanent consequences and may even result in their death.  As a result, the anger and pain that stem from these situations can tear a family apart. By being proactive, however, you can improve your odds of a better experience.

What You Can Do

I’ve mentioned it once but I’ll say it again – document EVERYTHING. Do your best to keep important conversations restricted to email but, if you do have an in-person discussion, you can always follow-up with that person and recap everything that was said. Again, this provides you with a paper trail.

Do some research and contact every senior resource in your area including the Department of Social Services, Medicaid, Medicare and everything in between. Get the correct information from the source and double-check anything the nursing home tells you.

You can also enlist the help of the local Ombudsman and/or an attorney that specializes in elder law. Not only can they help you navigate this confusing time in your life but they can be especially helpful if anything goes wrong.

No matter what, understand that this is going to be a stressful chapter in your family’s history. Any problems that already existed could easily deepen under these circumstances. Try to always give each other the benefit of the doubt, listen with an open heart and focus your energy on making memories with your aging loved one. Everything can change in an instant so make the most of every moment.

 Nursing home opposition hasn’t slowed a proposal to let Louisiana families install video camera systems in their loved ones’ nursing home rooms. Under the legislation, the cameras would be voluntary. The costs would have to be paid by the nursing home patient or family member. Any roommate — or a legal guardian — would have to agree to the camera installation. Nursing homes would be prohibited from ousting or retaliating against residents who choose to install the monitoring device.

Supporters said it would give family members the ability to monitor their loved ones from afar.  The nursing home industry lobbyists allege that live-streamed video could be hacked, facilities’ private medical records could be targeted and privacy could be threatened.  Many state senators seemed incredulous at the ridiculous objections raised by the Louisiana Nursing Home Association.

“I mean, really?” said Sen. Norby Chabert, a Houma Republican who pushed back against the claims.   Chabert said the nursing homes’ opposition seemed to suggest they don’t want people to be able to see their family members in real time. “That’s kind of fishy to me,” he said.

Supporter Lucie Titus, who said her mother, an Alzheimer’s patient, was unable to explain injuries she suffered in a nursing home. Titus asked to install a video camera system in her mother’s room and was refused by home administrators. She believes if she could have seen what caused her mother’s injuries, treatment could have been quicker and involved less pain. Titus filed a lawsuit to set up the video monitoring, but her 92-year-old mother died in November 2017 before the issue was resolved.

CNBC reported that Wall Street titans Goldman Sachs asked the incredible and amoral question: “Is curing patients a sustainable business model?”  Goldman Sachs addressed biotech companies, especially those involved in the pioneering “gene therapy” treatment and wondered if cures could be bad for business in the long run.

“Is curing patients a sustainable business model?” analysts ask in an April 10 report entitled “The Genome Revolution.”

The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies,” analyst Salveen Richter wrote in the note to clients. “While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.”

Richter cited Gilead Sciences’ treatments for hepatitis C, which achieved cure rates of more than 90 percent. The company’s U.S. sales for these hepatitis C treatments peaked at $12.5 billion in 2015, but have been falling ever since. Goldman estimates the U.S. sales for these treatments will be less than $4 billion this year, according to a table in the report.

“GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients,” the analyst wrote. “In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines … Where an incident pool remains stable (eg, in cancer) the potential for a cure poses less risk to the sustainability of a franchise.”

The report suggested three potential solutions for biotech firms:

“Solution 1: Address large markets: Hemophilia is a $9-10bn WW market (hemophilia A, B), growing at ~6-7% annually.”

“Solution 2: Address disorders with high incidence: Spinal muscular atrophy (SMA) affects the cells (neurons) in the spinal cord, impacting the ability to walk, eat, or breathe.”

“Solution 3: Constant innovation and portfolio expansion: There are hundreds of inherited retinal diseases (genetics forms of blindness) … Pace of innovation will also play a role as future programs can offset the declining revenue trajectory of prior assets.”

Newsweek had an article about a new study finding evidence to suggest that Alzheimer’s begins in childhood, with babies younger than a year old displaying signs of the disease. The research emphasized that earlier intervention is necessary to prevent the disease and addressing air pollution may play a key role.

Researchers examined the autopsies of 203 residents of Mexico City and published their findings online in Environmental Research. The bodies ranged in age from 11 months to 40 years old.

The researchers specifically looked at levels of two abnormal proteins associated with Alzheimer’s—hyperphosphorylated tau and beta amyloid. Many of the bodies displayed heightened levels of these two proteins in the brain, even in children less than a year old. Evidence of early signs of Alzheimer’s disease was found in 99.5 percent of the subjects examined.

The study theorized that exposure to air pollution may be behind these heightened abnormal protein levels in young brains. Children exposed to cleaner air performed better in various categories, including cognitive performance, lead study researcher Dr. Lilian Calderón-Garcidueñas, a professor in the department of biomedical and pharmaceutical sciences at the University of Montana, told Newsweek. Calderón-Garcidueñas, who also collaborates with Universidad del Valle de Mexico, compared children by age, gender, socioeconomic status, the IQ of their mother, nutrition and education.

WSPA reported that officials are working to establish a nursing home for veterans in Cherokee County.  The federal government has finally approved funding for its portion of the cost.  The federal government approving its portion of roughly $40 million to build a 108 bed nursing home for veterans on 35 acres off Hampshire Drive. He said 85 percent of the nursing home is being funded by the VA (Veterans Affairs), and the other 15 percent from the state.

“It’s going to be a very nice facility with security and very nice grounds,” Humphries said.

He said Cherokee County is paying for the land, and it’s an investment expected to impact the county’s economy through jobs during and after construction.

“As long as we have veterans, we’ll have this nursing home so this is a forever business coming to our community,” Humphries said. “We think it’s just a great opportunity to serve our community.”

“Especially the elderly people that are disabled… They need help,” Martin said.

McKnight’s had an interesting article about the changing demographics in nursing homes throughout the United States.  Younger residents are using facilities more often — bringing with them fewer physical demands and more behavioral health diagnoses.  Across the country, the under-65 proportion of residents climbed steadily from 16.5% of residents in 2011 to 17.4% in 2015. The rate jumped most for those between 55 and 64, up from 9.8 % to 11.1% in 2015.

“We’ve typically had this image of a nursing home of being (for) older adults, and now they are middle older adults,” said Ian Matt Nelson, a research scholar at Miami University’s Scripps Gerontology Center.  Nelson recently co-authored a report on this new generation of nursing home residents for the state of Ohio, where 20% of Medicaid long-stay residents were under 65 in 2015. That puts it 11th in the nation.

Co-author John Bowblis told McKnight’s that unpublished data from the study shows Utah leads the nation in the prevalence of young long-term care Medicaid patients, followed by Illinois, Nevada, Missouri and Arizona.

Almost half of the young Ohio residents had a diagnosis of severe mental illness — including bipolar disorder or schizophrenia — and nearly a quarter had paralysis. Those numbers compared to one-quarter and one-tenth, respectively, among seniors.

Meanwhile, younger residents are less likely to need help with activities of daily living that nursing home workers are typically trained to handle. In 2015, 28% of Ohio’s under-65 population had one or fewer ADLs.

Katherine Judge, a professor of psychology at Cleveland State University, told Crain’s Cleveland that younger adults will present a challenge for nursing homes.

“I think the implications are what are we doing on the community side and on the nursing home side to address the needs?” Judge asked. “It’s not clear for example what community services would best meet the needs of these individuals, or at this point how nursing homes might be able to offer different services to address their needs.”

 

The Daily Beast had an article about the investigation into the nursing-home death of the father of Trump’s ex-security advisor H.R. McMaster Jr. in Philadelphia last month.  According to the Philadelphia Medical Examiner’s Office, 84-year-old H.R. McMaster died at Cathedral Village nursing home in Pennsylvania and suffered “blunt impact head trauma”. Philadelphia State Police have labeled the death “suspicious.”

The allegations are that McMaster Sr. did not receive proper care, according to 6ABC. McMaster supposedly fell, hit his head and was placed in a chair, then died, 6ABC reported. The senior was admitted to the facility after having a stroke, the station said.

“As soon as we became aware of the alleged incident, we began an internal investigation and contacted the appropriate authorities,” Cathedral Village said in a statement to CNN, adding the “safety” and “welfare” of the patients is the facilities “utmost priority.”

However, over the last two years, Cathedral Village has failed four state inspection reports, according to Pennsylvania Department of Health records.

Last January, an inspection report revealed that four nurses were working despite expired Nursing Assistant Certifications. Nearly six months later, the agency failed to follow a doctor’s requirement of applying daily gauzes on a patient’s surgical incision. According to observation reports, the patient’s sheets were filled with blood and “yellow and brown colored drainage.” A fetid odor was also emitted from the dressing area, records show.

Two years ago, the nursing home failed to provide one-on-one activities for a clinically depressed patient who also had a stroke, state records show. According to the report, the only activity the patient had was a “television in the room.” That year, the facility also failed to keep accurate clinical records, reports show.