Linda Searing of The Washington Post wrote the following:

Every 40 seconds, on average, someone in the United States has a stroke — amounting to 795,000 people a year, according to the Centers for Disease Control and Prevention. Most strokes, 80 percent or more, occur when blood flow to the brain is blocked by a clot. Known as an ischemic stroke, it results in brain cells not getting needed oxygen and nutrients, which causes the cells to start dying within minutes.

The other main type of stroke, hemorrhagic stroke, occurs when a blood vessel in the brain leaks or bursts, with the flood of blood putting pressure on and damaging the brain cells. This type of stroke may be caused by high blood pressure (which over time can weaken blood vessel walls) or an aneurysm (a bulge in a blood vessel that bursts).

Both types of stroke can cause lasting brain damage, disability or death, and some 140,000 Americans die each year from a stroke. The likelihood of brain damage and disability increases the longer a stroke goes untreated, making it critical to call 911 and get emergency stroke treatment started as soon as possibleSigns of a stroke usually come on suddenly and may include numbness or weakness in the face, arm or leg, trouble speaking, blurred or double vision, dizziness or stumbling when trying to walk or a very severe headache.

A condition similar to a stroke, known as a transient ischemic attack, occurs when the blood supply to the brain is blocked for a short time (hence its nickname, “mini-stroke”). Though damage to the brain from a TIA is not permanent, it does make the chances of a full-blown stroke more likely. Because of this, the American Stroke Association refers to a TIA as a “warning stroke.”

Nursing home residents and workers may be among the first to receive a coronavirus vaccine, depending on what a federal committee decides. A preliminary plan reveals that critical medical and national security officials would receive any approved vaccines first, followed by other essential workers and those considered at high risk, such as the elderly and people with underlying conditions.

The Centers for Disease Control and Prevention and an advisory committee of outside health experts currently are working on a priority ranking for upcoming vaccines. The committee, which has been deliberating on the vaccine prioritization since April, reports to the director of the CDC. It includes 15 voting members selected by the health secretary who come from immunology, infectious disease and other medical specialties; 30 nonvoting representatives from across the health field; and eight federal officials focused on vaccines.

“This virus disproportionately impacts older adults, particularly those over 80 with chronic diseases, which comprises the majority of the population we serve,” they wrote in a letter to HHS Secretary Alex Azar. AHCA/NCAL added that top priority is warranted for the groups since “those we care for are the most vulnerable to the virus.”

Oregon’s Supreme Court ruled that the $500,000 cap on such damages under state law violated the constitutional guarantee of access to a remedy in the courts.

“In enacting the damages cap (in 1987), the Legislature left defendants’ common-law duty of care intact, but deprived injured plaintiffs of the right to recover damages assessed for breach of that duty,” Chief Justice Martha Walters concluded for the court majority of five.

A man who lost his left leg after a garbage truck struck him in March 2015 will now get a chance to argue for an award of noneconomic damages exceeding $500,000.  The business had already conceded liability for the injury, so the sole issue was the amount of damages.

Scott Raymond Busch, now 62, was awarded $10.5 million in noneconomic damages — known as “pain-and-suffering damages” — plus $3 million in economic damages by a jury in May 2016.  Busch’s left leg ended up under the truck and had to be amputated above the knee. Circuit Judge Michael Greenlick then reduced the award for noneconomic damages to the $500,000 allowed under a 1987 law. (That amount, if linked to inflation, would be slightly less than $1.2 million today.)

The Covid-19 pandemic has energized calls for a drastic solution: closing nursing facilities altogether. This year, Covid-19 has killed around one in every 35 nursing home residents in the United States—over 50,000 people. More than 1000 nursing facility staff members have also died from the disease. Even in the best of times, the industry struggles with quality care because of short-staffing, poor infection control, and abuse and neglect.

Why do we have these facilities where people are not receiving proper care?” said Susan Dooha, the executive director of the Center for Independence of the Disabled, New York. “Maybe we don’t need them.”

Deinstitutionalization is the effort to expand at-home or in-community care options for disabled people in need of long-term care.  In the US, such ambitions have run up against the for-profit nursing home industry funded by billions of dollars of taxpayer funds through Medicare and Medicaid payouts. That industry is tasked with providing care to vulnerable people in the nation. Institutional care is more expensive, and even though many nursing home facilities suffer from what critics say is a well-documented history of problems.

Advocates say problems have only intensified as large corporations began consolidating nursing home franchises. Around 70% of nursing homes in the US are under for-profit ownership, and, since the 2000s, private equity firms have purchased many facilities, hoping to cut costs and increase profits. One recent analysis, published by the New York University Stern School of Business, found “robust evidence” that private equity buyouts were linked to “declines in patient health and compliance with care standards.”

Nursing homes became commonplace in the 20th century, enabled by twin shifts in American life: government aid for the elderly, and medicine that allowed more people to reach an age where they could actually use it. Such facilities began multiplying shortly after the passage of the Social Security Act in the 1930s, and they expanded with the introduction of federal- and state-run health programs like Medicare and Medicaid in the 1960s. Nursing homes are distinguished by their capacity to provide skilled nursing care and, typically, 24-hour support for residents.

In the early 2000s, policymakers began doing more to prioritize home care for people who might otherwise have ended up in a facility. Emphasis was placed on supporting patients who could receive care in their own homes, either from family members or home health aides. A major 2018 survey from AARP, the aging-advocacy organization, reported that close to four in five Americans aged 50 and above prefer to age at home. “Most older people are anxious about the prospect of moving into a nursing home,” a recent analysis of studies in high-income countries reported, and studies consistently show high rates of depression in facilities.

For years before Covid-19, researchers have warned that norovirus, influenza, and other infections can spread rapidly in nursing facilities. Those risks have increased in recent years, as nursing homes take in more short-term residents who are getting rehabilitation after hospital visits, and who potentially bring infections into the building with them, said Lona Mody, who runs the Infection Prevention in Aging Research Group at the University of Michigan Medical School. In addition, Mody said, “staff members’ compliance to hand hygiene in the past has been not good.”

The scale of suffering during the pandemic has led to calls for change. “We’ve created this system, and now we’re telling all the people who work in it to just make it work. And it doesn’t work,” said Sonya Barsness, a gerontology consultant who works on reforming nursing home culture. “This pandemic,” she added, “has brought light to the reality that the system is not adequate to support the needs of people as they grow older.”

After COVID-19 has prevented loved ones from seeing their family members. Families are pleading with lawmakers in South Carolina, Connecticut, Ohio and other states to allow cameras to see loved ones. The visitation bans are necessary evils but they have negative effects. There is renewed interest in legislation that would allow families to put remote cameras inside the facilities to help see how loved ones are doing. About a dozen states already have laws or regulations in place allowing residents and their families to install video cameras, subject to certain rules.

The cameras allow families to monitor loved ones in real time or make recordings. In most cases, residents can ask that they be turned off for privacy. There are safeguards to protect roommates from being filmed unknowingly. Signs in rooms alert staff and visitors that the cameras are operating.

McKnight’s had an interesting article on what can be learned from the nursing home industry’s response to the coronavirus including increasing communication through online webinars where the staff can answer questions. Communicating effectively with staff also has been key.

“From bolstering communications to supporting staff to stepping in to help residents in the absence of visitors, many providers around the country have used the pandemic not to merely maintain operations, but to improve them.”

“It’s really created a comfort to families that they have a live stream with the facility,” he says. “It’s like putting on a familiar TV show … We didn’t expect that. In a general sense, it’s been a chance to express their gratitude and appreciation for the work we are doing under extremely challenging circumstances.”

“From the very beginning of the pandemic, our response efforts included the widespread and consistent use of Zoom meetings for education, communication and leadership support,” says Cheri Kauset, vice president of customer experience and communications for Tampa, FL-based Mission Health. “We even implemented quick and easy ‘Leadership in a Minute or Less’ tutorials at the beginning of our weekly calls to help guide our community leadership through some of the unique challenges they’re facing.”

The nursing home industry are seeing steep drops in occupancy since the start of the pandemic.  Experts do not expect those numbers to rebound any time soon. Weekly occupancy data trends from the federal government’s National Healthcare Safety Network’s database revealed median occupancy rates for skilled nursing providers have fallen as low as 75% in each of the three most recently reported weeks, according to CLA.

“For facilities that lost existing occupancy due to a COVID-19 outbreak, when coupled with a reduced incoming stream of residents, skilled nursing leaders expect it may be 18 months before their occupancy can recover to pre-COVID levels,” Cory Rutledge, managing principal at CliftonLarsonAllen, told McKnight’s Long-Term Care News.

“In addition, some skilled nursing facilities have experienced a significant occupancy decline due to COVID-19 infections in their building, which augments the issue,” he added. The National Investment Center for Senior Housing & Care said the pandemic and falling occupancy numbers have put the industry in a “challenging state,” but added the struggles won’t continue forever and nursing home care will eventually be needed.

Altarum’s Center for Value in Health Care detailed the spending decline in nursing homes this year in a new report. Spending for nursing home care dropped 7.2% from April to May despite other healthcare sectors showing signs of recovery amid the ongoing coronavirus pandemic. Analysts said they expect a gradual decline through at least the end of the year. Overall, nursing home care spending is down 12.7% from February.

The ongoing coronavirus pandemic has the skilled nursing industry in a challenging state right now after new data revealed occupancy at SNFs dropped to 78.9% by the end of April. In March, SNF occupancy had dropped to 83.4%, which were the lowest levels since 2012.

Rhyan also noted that employment in the sector fell 3% and 4% in April and May, respectively, when compared to last year. He added that though the industry is likely seeing increased spending in patients who require care for COVID-19, that’s being offset by a reduction in other types of care. He expects to see a continued decrease in spending as COVID prevalence increases across the country.

“Nursing homes did not have as near of a steep drop that in April, but we are seeing now this persistent decline into May,” senior analyst and report co-author Corwin Rhyan explained that the sector has seen a more “moderate decline” when compared to the other healthcare industries during the pandemic.

The ability for spending in the sector to rebound will depend on the “extent to which nursing homes get the virus under control,” added George Miller, report co-author, fellow and Research Team Leader for Altarum’s Center for Value in Health Care. “That’s a little hard to predict,” Miller said.

The findings also revealed that Medicaid revenue patient per day increased by $10.53, or 4.9%, when compared to April 2019.

The L.A. Times reported that nursing homes continue to violate federal law by “dumping” residents. Los Angeles prosecutors accuse a Lakeview Terrace skilled nursing facility of illegally “dumping” old and disabled residents onto the street and into homes that are not equipped to care for them in order to increase profits amid the coronavirus epidemic.

The “sustained” and “intentional” misconduct by the facility comes as nursing homes have an incentive to dump long-term residents to make room for COVID-19 patients, for whom they are paid much more.

Under Medicare’s new guidelines nursing homes are paid substantially more for new patients, especially in the first few weeks of their stay. So COVID-19 patients can bring in more than $800 per day, according to nursing home administrators and medical directors interviewed by the Times. By contrast, facilities collect as little as $200 per day for long-term patients with dementia, the newspaper said.

“This creates an incentive for nursing homes to seek out residents with higher rates of reimbursement and ‘churn’ residents by any means possible,” prosecutor Feuer wrote.

In one instance an 88-year old man with dementia was transferred from the nursing home and was later found wandering the streets profoundly confused a day later, according to the court filing. Another resident with HIV who was dumped on the street instead of being provided the hospice care he needed wound up cowering in a friend’s backyard, hoping that would keep him safe from the pandemic, the complaint said.

Lakeview Terrace, which has the lowest possible quality rating from Medicare, has a troubled history. Last year the city attorney filed a complaint that accused the facility of patient dumping, failure to provide residents with necessary care, failure to protect their safety and failure to maintain accurate and complete medical records.

The home’s administrators agreed to pay $600,000 as part of that settlement, $150,000 of which would cover the cost of an independent monitor. The home appeared to cooperate at first, Feuer said in an interview with the Times, but after COVID-19 arrived all outside visitors were barred from the building, including the monitor. That’s when the situation deteriorated rapidly, Feuer said.