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.

 

The Business Times reported the financial difficulties of one of the major national for-profit nursing home chains.

US healthcare landlord Quality Care Properties Inc said on Friday that it can seek receivership for the country’s second-largest nursing home chain, HCR ManorCare, after it failed to make a US$79.6 million payment for current and past rent.

In a statement, Quality Care said it had delivered a notice of default to HCR ManorCare, its main tenant, regarding the missed payment, which Quality Care said triggers immediate payment of $265 million in additional overdue rent.

Private equity firm Carlyle Group bought HCR ManorCare in a 2007 leveraged buyout for $6.3 billion and sold the properties to HCP for $6.1 billion in 2010.

I guess they are done siphoning funds away from patient care to line their own greedy pockets.

New Jerseyans can now monitor how their loved ones are treated in nursing homes and other institutional care facilities with hidden cameras provided for free by the state.

Want to get a Safe Care Cam? Call (973) 504-6375 and leave a message in a voice mailbox that will be regularly monitored by Division staff responsible for the program’s day-to-day operation. Or call the Division on its toll-free line and follow the voice prompts to leave a message: 1-800-242-5846 .

Attorney General Christopher S. Porrino and the Division of Consumer Affairs announced that they’d opened the program to residents who want to use micro-surveillance cameras in nursing homes, assisted-living facilities, residences for the developmentally disabled and other care facilities.

“Extending Safe Care Cam’s reach into residential facilities permits more people to monitor how caregivers are treating their loved ones when they think no one is looking,” Porrino said.

The Safe Care Cam program was launched last December to address New Jersey’s growing concerns about patient abuse. Those fears, being played out across the nation, have been fueled by increased media accounts of caregivers caught on hidden cameras physically or verbally assaulting innocent patients and residents.

The Safe Care Cam provided “insight to what really goes on when nobody is supposedly watching” and gave her family reassurance that their mother was receiving the care they had hoped and expected she would, the woman said.

The New York Times reported the Trump Administration’s attempt to take away poor and elderly Americans right to compensation when they are victims of medical malpractice or defective drugs or medical devices under a bill drafted by House Republicans as part of their plan to replace the Affordable Care Act.

The bill would set a $250,000 limit on “noneconomic damages,” which include compensation for pain and suffering, permanent impairment, scarring, mental anguish etc.

The bill would impose new arbitrary limits on lawsuits involving care covered by Medicare, Medicaid or private health insurance subsidized by the Affordable Care Act. The limits would apply to some product liability claims, as well as to medical malpractice lawsuits involving doctors, hospitals and nursing homes.

Kimberly A. Valentine, a lawyer in Orange County, Calif., who has represented scores of nursing home residents, said the House bill “would make it much more difficult for victims of elder abuse to seek redress and would eliminate one of the most powerful tools we have to improve care in nursing homes.”

 These arbitrary limits would not reduce health costs, increase access to care, or save taxpayers any money.  The only things it will do is limit restitution and increase malpractice. Several studies suggest that litigation costs, including damage awards, legal fees and the alleged effects of “defensive medicine”, may represent only 2 percent to 2.5 percent of national health spending.

The bill would also restrict the ability of victims to contract with lawyers in clear violation of the Constitution. Why is the government involved in a private contract between attorneys and their clients?

A new study conducted by researchers at Brigham and Women’s Hospital, an affiliate of Harvard Medical School, has found that the number of medical malpractice claims paid by physicians have substantially decreased over the last two decades. The study, entitled “Rates and Characteristics of Paid Malpractice Claims Among U.S. Physicians by Specialty, 1992-2014,” is one of the first of its kind, as it analyzes and categorizes the data by medical specialty.

The study, published online by the American Medical Association’s medical journal, JAMA Internal Medicine, was conducted for the purpose of characterizing by specialty the trends in medical malpractice claims paid on behalf of United States physicians. The National Practitioner Data Bank, a centralized database of paid medical malpractice claims, was utilized by the researchers to gather data from 1992 to 2014. All dollar amounts were adjusted to 2014 dollars using the Consumer Price Index.

The researchers found that over the course of the twenty-two year time period, the overall rate of medical malpractice claims paid on behalf of all United States physicians decreased by 55.7 percent.

The research indicated that the most common allegations of malpractice were misdiagnosis (31.8 percent of all claims), errors related to surgical procedures (26.9 percent), and treatment-related mistakes (24.5 percent). Approximately 32 percent of all paid claims involved the death of a patient.

 

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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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.

The Washington Times had an article about the attacks on the 7th Amendment to the Constitution.

Most Americans can identify only a few of the Amendments of the Bill of Rights including the Seventh Amendment (the right to a civil jury trial).  The right to a jury trial is the most important right given to us in the Constitution. How do we know this? It is the only right specifically mentioned in two of the amendments to the Constitution. The right to a jury trial in a criminal case is granted in the Sixth Amendment and the right to a jury trial in a civil case is guaranteed in the Seventh Amendment.

America’s founding fathers revered the jury trial system, for both the civil and criminal case. In 1751, in South Carolina, the state legislature declared that “any person who shall endeavor to deprive us of so glorious a privilege of trial by jury,” was an enemy of the people.

In 1776, George Mason wrote in Virginia’s Declaration of Rights, “The ancient trial by jury is preferable to any other and ought to be held sacred.”  It is held sacred, except by the big business corporatists who believe that rights exist only for the corporate elites and not for the average American citizen.

Unfortunately, President Trump has bought into the myth of the frivolous lawsuit.  Frivolous lawsuits are a fable made up by the Chamber of Commerce and big insurance, which want to deny citizens their day in court. Lawyers don’t file frivolous lawsuits because they don’t make money from them. Lawyers can and sometimes are sanctioned for filing a lawsuit that is deemed to be frivolous.

The only other defense of the Seventh Amendment comes from the House Freedom Caucus. This liberty-minded group in the House of Representatives has risen to the defense of the Seventh Amendment before. But with the House Freedom Caucus consisting of only thirty-two members, out of the 237 Republicans in Congress, it is really questionable how much they can do.

Millions of Americans, including recently President Trump, have said, “I’ll see you in court.”  If Tort Reform is adopted, it will be the beginning of the end for the Seventh Amendment and the right of Americans to sue.

Thomas Jefferson said, “I consider trial by jury as the only anchor yet imagined by man, by which a government can be held to the principles of its constitution.”

President Trump would do well to heed the words of President Jefferson and abandon the unconstitutional idea of Tort Reform.

Responsibility and accountability – even for the powerful – are rooted into the core of our legal system. This country’s founders knew that a democracy needs a court system that empowers people to protect themselves by holding the powerful to account. That’s why the Constitution guarantees each person the right to a trial by jury. The founders feared unaccountable power in the form of the King of England against his “subjects.” 21st Century America may not have a king, but it does have billion dollar corporations touching every part of every person’s life. These corporations now seek the kind of unaccountable power our founders sought to protect against, and they’re seeking that power by destroying your constitutional right to a trial by jury.

Politicians who are in the pockets of large corporations and insurance companies have devised a plan specifically aimed at destroying our right to hold those in power accountable for their misdeeds. Their plain is to enact laws that will all but destroy your right to use the judicial system to protect yourself. They have introduced bills which, if passed, will enact arbitrary changes to courts all across the country, including:

  • Limiting compensation for injuries caused by medical professionals, including doctors, hospitals, nursing homes, and medical device manufacturers,

to $250,000.00, regardless of how much that injury devastated your life

or the extent of malfeasance by the medical professional or company.

  • Eliminating class-action law suits, which would essentially destroy the ability to bring the kinds of cases that keep us safe
  • Eliminate Individual States Law regarding lawsuits and forcing all cases to Federal Court
  • Allowing insurance companies to make “payments” rather than paying full compensation.

We must tell our government to put people first and stop trampling on our rights. Javerbaum Wurgaft has been protecting citizens of New Jersey and New York by demanding that everyone is treated fairly, regardless of gender, race, or economic status. Please join us in demanding that Congress do the same. We must ban together and contact our representatives to demand they say NO to these outrageous attacks on our rights. Go to each link below and tell them NO!

The Washington Post reported that the House Republicans are advancing a series of bills that would make drastic changes to the civil justice system long sought by insurance company lobbyists and global corporations, including a cap on medical malpractice awards and additional roadblocks for classes of people seeking to sue jointly to address harm.

Civil rights and consumer groups oppose the measures, saying they would severely limit the ability of average Americans to pursue legal remedies from powerful institutions. In a letter to congressional leaders, opponents said the measure would have a “chilling effect” on a broad range of complaints, including civil rights violations, employment discrimination and environmental abuses.

One proposal would limit monetary awards in medical malpractice suits to only $250,000 for noneconomic damages, which include pain and suffering, mental anguish, loss of enjoyment of life, and permanent scars.  The caps would apply broadly to all manner of medical malpractice, including errors in surgery, side effects from unsafe drugs, abuse and neglect in nursing homes, and sexual assault by doctors.

 None of the four proposals has been aired in a congressional hearing. House leaders “are turning the legislative process into a kind of subterranean operation,” said Rep. Jamie B. Raskin (D-Md.), a leading opponent of the bills. “While the populace is spellbound by [Trump], the conservatives in Congress are dismantling access to justice and our tort civil liability system.”

Joanne Doroshow, executive director of the Center for Justice& Democracy at New York Law School, called the fast-paced legislative campaign to overhaul multiple parts of the civil court system “unprecedented.”

“These bills, put together, would exonerate large corporations and the health-care industry for any kind of harm they may cause everyday people,” Doroshow said.

Doroshow and others said the Fairness in Class Action Litigation Act would squelch most class-action lawsuits, which typically involve plaintiffs with a wide variety of similar complaints.