St. Louis Today reported that troubled nursing home St. Sophia Health and Rehabilitation Center received notice in October that Medicare and Medicaid would not pay for any new residents through the government insurance programs starting Nov. 2.  The 240-bed nursing home is owned and operated by Midwest Geriatric Management, or MGM Healthcare, which owns 22 facilities in three states.

The latest problems stem from a resident who pulled out a dialysis catheter and bled to death in September.  The death marks the second in two years that federal investigators linked to negligence at the nursing home. An 88-year-old woman with Alzheimer’s disease was found dead in a bathtub at St. Sophia last year after being left unsupervised for eight hours.

An investigative report dated Sept. 28 by the U.S. Centers for Medicaid and Medicare Services details the events based on interviews with St. Sophia staff and an emergency responder:

The patient came to St. Sophia on Sept. 7 with diagnoses that included heart failure, dementia, one-sided paralysis and a seizure disorder. The patient had a catheter for vein access in an arm, a dialysis catheter in the groin area and a feeding tube. The patient was also taking blood thinners. On Sept. 8 and Sept. 9 nurses reported the resident continually pulled at the tubing and “requires constant watching.”

At 4:18 a.m. on Sept. 9, a nurse noted that the patient continued to pull at the tubing. The next entry at 6:50 a.m. says the nurse “was called to the room to find a significant amount of blood on the floor and bed” after the patient pulled out the stitches and catheter. At 6:55 a.m. the patient was unresponsive, according to the nurse’s notes.

Investigators discovered that the patient’s electronic medical record was changed two days later to add notes at 5:42 a.m. and 6:38 a.m. showing all tubing intact.  A nursing aide told investigators the patient pulled the feeding tube out earlier the same night. The aide told two nurses “all night, about a thousand times, what the resident was doing” but was not instructed to stay with the patient, according to the inspection report.

An emergency medical technician who was called to the facility later told investigators some of the blood that pooled under the bed was coagulated on arrival. “The resident was not conscious. Staff were unable to say when the incident happened or when (the patient) was last seen. Their stories conflicted,” the EMT told investigators.

 Police were also called to the facility Nov. 3 after receiving a report of sexual abuse. Health inspectors returned to St. Sophia on Nov. 20 and found that on two occasions a resident sexually assaulted another resident who is severely mentally impaired, according to staff interviews.
The family of a resident reported another problem later that month. CuSandra Wright said her mother Mabel Wright, 71, remains hospitalized and unresponsive after falling out of bed at St. Sophia on Nov. 28. Nursing homes can be cited by regulators if a fall was determined to be preventable.

In an article from the University of Missouri News Bureau, Sheena Rice details a new federal report which reduced hospitalizations and saved Medicare thousands of dollars per person. Read an excerpt below:

Researchers from the University of Missouri Sinclair School of Nursing are continuing to see success in their work to improve quality of care in nursing homes. In 2016, a federal report found that the Missouri Quality Initiative for Nursing Homes (MOQI) reduced potentially avoidable hospitalizations by 48 percent and reduced hospitalizations from all causes by 33 percent. This reduced total Medicare expenses by $1,376 per person, saving 33 percent of the costs of all-cause hospitalizations and 40 percent of potentially avoidable hospitalizations.

You can read the full report here.

Freelance Contribution by Karen Weeks

In older age, people often find themselves with an abundance of free time. What better to do with it then learn a fun new skill? With today’s technology, it’s easier than ever. Here are several skills seniors can add to their portfolio by taking just a few online courses.


Whether you’re searching for the best online guitar lessons or how to play the piano, you’ll find you won’t be at a loss for videos that teach you all about playing an instrument online. Not only are there video guides, but there are games and music theory worksheets as well that will help you learn to read music and find the notes on your instrument of choice. It takes a lot of commitment to learn to play an instrument, but if you practice daily, it’s a skill that will bring joy to everyone around you.


If you’ve always wanted to cook like a pro, but never had the time to devote to the kitchen, there are an abundance of free videos and step-by-step instructions with visual aids online to help you achieve your goal. Several classes on “cover basic and advanced cooking techniques, including cooking meat, using herbs, working with seafood, creating sauces, assembling appetizers, cooking vegetables and using pastry dough.”

The best thing about learning to cook a particular recipe through a video is the fact that you can always rewind or pause it if you need more time before moving on to the next step. With the internet at your fingertips, you’ll also never be at a loss for ideas on new recipes to whip up.


Whether you’re wanting to unlock your camera’s full potential, take photos of the grandkids, or better document your next trip, there are several free online tutorials available to help you excel in photography. You’ll also find tips on how to compose your photos and utilize the right lighting, as well as the ins and outs of editing software like Photoshop. Make sure you have a camera and its manual handy before starting any courses because they might confuse you if you don’t have something to practice and follow along with.


While speaking a foreign language may seem like quite the task, online computer programs like  Rosetta Stone allow you to listen, practice speaking it yourself as well as with other people from around the world, and see visual examples of how the language is used in the correct context. According to The Guardian, users are usually “able to pinpoint their specific needs, be that tailoring a classroom lesson to the interests of a particular age group, or learning the basics for a holiday abroad.” The way each lesson is set up, it often feels more like you’re playing a game than studying a new complex linguistic pattern. Additionally, though learning a language online will cost you, it affords you the opportunity to go at your own pace and difficulty setting.

In order to make the learning process easier and more entertaining, many of these skills can be picked up and shared with a group of friends. When in doubt, search the likes of YouTube to find a helpful video. You might even find that learning a new skill as a senior will keep your brain on its toes and increase your sense of fulfillment.

Freelance Contribution by Jessica Walter. 

As you may well know, falls are a serious matter in the elderly, and according to the NCOA are the leading cause of fatal injury. Many of these happen at home, where those with accessibility requirements are living in inadequate environments.

Every year, children of the elderly make various alterations and adjustments to their parents’ homes in pursuit of making them safe. Whilst home modifications for seniors are essential and effective, there are some measures you can take to make the home both promote independence and feel intuitive.

Introducing High Quality Rails

It sounds simple, but introducing rails in areas of the home can be incredibly beneficial for a number of reasons. The homeowner doesn’t necessarily need to be expressly disabled, or diagnosed with an ability that affects their mobility. Having rails in areas like the bedroom and bathroom enable anyone to safely navigate their home and prevent falls that can cause long-lasting harm. Essentially, rails are one of the most straightforward ways to ensure senior’s safety at home

There are a huge variety of rails out there, too, to fit with different home styles and setups. This means the homeowner doesn’t need to compromise the efforts they’ve put into getting the home how they like it, benefiting their sense of independence. No more plain white bars as you’ll see in public buildings.

Creating Wheelchair Accessibility

Again, this isn’t even necessarily a measure that is strictly for those who use wheelchairs. Ramps can provide an easier way to get in and out of the house, as well as for transporting heavy goods where stairs are a barrier to getting purchases into the house. The chances of tripping and falling whilst on a ramp are significantly lower and it also means the house is future proofed in case of any changes in future years.

Just like the rails we’ve spoken about above, the homeowner doesn’t need to compromise design for a ramp, either. There is a wide range of ramp styles so the house doesn’t have to have something dropped into it that isn’t appropriate for the overall design of the house.

Internet of Things

The likes of Amazon and Google have released products in recent years with very detailed voice recognition and incredibly intuitive responses to questions. They can also be tuned for a wide variety of circumstances, including those that might affect your parent. They can act as an early warning system, as well as a way to easily contact relatives. Elderly parents can sometimes need to re-learn new technology, but it’s not difficult to learn and could be very useful in maintaining independence whilst assisting.

Home alterations can be frustrating in the way they change the face of the home, but they are necessary. However, home alterations don’t have to be intrusive and there’s many ways to preemptively make a house independent whilst not compromising style.

The New York Times reported on Trump’s decision to abandon a rule that would have protected nursing home residents from injuries caused by substandard care, abuse or neglect.  Trump will now allow nursing homes to require residents to waive their constitutional right to a jury trial by requiring the residents to sign mandatory pre-dispute arbitration clauses as a condition of admission to the home.

“About half of nursing home residents have Alzheimer’s disease or other dementia, according to the National Center for Health Statistics, and consumer advocates say harried family members could easily miss the arbitration clauses as they move a loved one into a home offering care.”

The attorneys general of 16 states, led by Brian E. Frosh of Maryland and Xavier Becerra of California, and consumer advocates strongly opposed the Trump administration proposal.  Thirty-one senators, led by Ron Wyden of Oregon and Al Franken of Minnesota, both Democrats, also objected to the Trump administration proposal. With Medicaid and Medicare spending more than $80 billion a year on nursing home care, they said, nursing homes should not be able to cover up wrongdoing by forcing patients to relinquish the right to sue.

Long-term care ombudsmen, who receive federal funds to serve as advocates for nursing home residents in each state, are skeptical of the new initiative. “The proposed rule would undermine the rights of people living in nursing homes — rights established in a 1987 law,” said Patty Ducayet, the Texas ombudswoman, who is a state employee.

Guest Post by: Andy C.; Targeting Cancer (TCA)

Being diagnosed with cancer is a difficult time, not just for the patients but for the family too. Living with a cancer patient means that you will not only have to provide them with physical support but will also provide them with enough emotional support.

At the end of the day, irrespective of the kind of support you provide a cancer patient you need to make sure that you have the right information to pass on to them as well. This means that the sources from where you obtain your information which will consequently allow you to streamline your support strategies for them need to be reliable. Whether it is finding out more about radiation oncology information and other radiology techniques or finding out more about cancer support groups for them to join your job as a caregiver for a cancer patient has no room for any loopholes.

There are experts available in every field to help you out with any problem you may encounter. However, even with this extra assistance you may still find a couple of hassles. A good example to demonstrate this is the dietary recommendations which the cancer patients receive. When undergoing treatment, one of the most common side effects that cancer patients experience is the loss of their appetite. They find it difficult to maintain a healthy diet, but still their body needs the nutrition to keep fighting.

A nutrition expert who recommends individual diet plans for cancer patients that are evidence based can be of great help. Unfortunately, not all cancer patients receive these recommendations. They or their families then turn to the internet where they spend countless hours looking for dietary recommendations. We do not mean to label all the internet resources for providing information to cancer patients as unreliable, but generally there is a lack of consensus which is observed in what they all have to say.

One source will have you follow one rule which will only be marked as something which must be avoided in all cases by another source. You cannot afford this kind of confusion when providing care for a cancer patient. One wrong move can cause you a string of very serious problems.

Some of the information that you look for online can also give you false hopes. Everyone knows that clinical trials are an important part of cancer treatment. Every day there are clinical efforts being made to make treatments for various types of cancer as effective as possible. Reading about the findings of these clinical trials especially of those where they have unearthed some groundbreaking information can be very encouraging.

They can be encouraging only when they are coming from authentic sources!

A good idea here would be to cross check information that you obtain from the internet. If something does not add up, make the extra effort to reach out to cancer specialists and seek their professional opinion.

You are looking after somebody’s life; you have got to be careful. had two articles (here and here) about James Square Nursing and Rehabilitation Center.  In 2015,  two out-of-state nursing home operators cut jobs at the 440-bed facility to save money.  A recent inspection found there were so few certified nurse aides some residents had to eat meals in bed and could not get up until late in the day.  A shortage of nurses and aides led to medication errors, delays in people getting showers and incontinence care, a woman falling out of a wheelchair and fracturing her shoulder and many other problems, according to the inspection.

In the unusual raid, armed investigators from the AG’s office seized records from the nursing home.  The inspection report said fewer nurses and aides were working in January than James Square’s staffing schedules showed. The inspection found discrepancies between those schedules and documented time clock and time sheet records.

Four families have filed lawsuits claiming a loved one died because of poor care and neglect.  The lawsuits claim James Square administrators failed to adequately staff the facility with qualified people, and failed to promote quality of care to the residents. A large number of wrongful death claims could be an indicator of patient care problems, according to a nursing home expert.

Richard Mollot, executive director of the Long Term Community Care Coalition, called the number of wrongful death claims at James Square “extremely troubling.”

“People very rarely sue when there is nursing home neglect or abuse, even when it leads to the death of the resident,” Mollot said.”If a facility has been sued by several different families it indicates, to me, that there is a risk that poor care may be persistent or widespread, or both.”

The Senate version of the American Health Care Act institutes deeper Medicaid cuts than the House bill to help pay the cost of its expensive tax credits. The House version holds the program to the inflation rate plus one percent — which is historically lower than medical costs have risen, meaning that the program would have to curtail benefits for its beneficiaries, who tend to be poor and very sick. The Senate bill would cut growth down to the inflation rate, without the extra one percent.

The most important design feature is that the Senate bill retains all the tax cuts in the House bill. By eliminating nearly a trillion dollars in revenue, it necessarily creates a trillion dollars in cuts for coverage subsidies.


New York Magazine had an article about GOP moderates worried about TrumpCare’s health care cuts affecting the opiod crisis.  “During the worst year of the HIV/AIDS crisis, 43,000 Americans lost their lives to the virus. In 2015, 52,000 died of a drug overdose. Never in recorded history had opioids killed so many Americans in a single year; the drug-induced death toll was so staggering, it helped reduce life expectancy in the United States for the first time since 1993.”

The Medicaid cuts in TrumpCare will devastate addiction resources.  Medicaid expansion accounted for 61 percent of total Medicaid spending on substance abuse treatment in Kentucky, 47 percent in West Virginia, 56 percent in Michigan, 59 percent in Maryland, and 31 percent in Rhode Island. In Ohio, the expansion accounted for 43 percent of Medicaid spending in 2016 on behavioral health, a category that includes mental health and substance abuse.

As the New York Times reports:

Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act.

But that, too, is running into opposition from conservatives. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine.

Without some opioid funding, Mr. Portman cannot vote for the bill, he said, adding, “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”

Contagion Live had a discussion with Nicola Thompson, PhD, epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention who shared what is needed to estimate the burden of healthcare-associated infections in nursing homes.

Interview Transcript (slightly modified for readability):  “There has been a lot of work outside of the United States, in Europe, and also recently in the United States by the Centers for Disease Control and Prevention (CDC) to look at the prevalence of healthcare-associated infections in acute care hospitals. That data that has been collected has been used to translate the prevalence of infection into the burden over the course of the year. That has been done by a long-standing formula that has been out and has been published and used many times. That formula includes in it information on the average length of stay [for a patient].

Essentially the model that is used to estimate the burden of healthcare-associated infections from the prevalence takes into account the average length of hospital stay for people with a healthcare-associated infection, compared [with] the average length of hospital stay for people without a healthcare-associated infection. Those are the pieces for the inputs for the model. The differences between lengths of stay is used to estimate the national burden [of disease].

The concept of ‘length of stay’ does not really hold up when we think about the nursing home setting because the vast majority of people that are in a nursing home go there long-term to receive care and they are not anticipating a discharge. [Therefore,] we need to come up with a different approach to estimating the burden of [healthcare-associated] infections in nursing homes that does not rely on information, or take into account information on length of stay. That is really where the work that has been done by the European CDC (ECDC) to look at the burden estimation in nursing homes has been helpful to us.”