Terry Story from Muncie, Indiana had a great letter to the editor of the Star Press.  See below:

How shameful that some lawmakers consider a bill specifying minimum nursing staff ratios in health facilities as "too controversial."

My parents lived in three local nursing homes because of late-stage dementia. I visited them almost daily and observed first hand how chronic understaffing impacts residents’ well being. Cognitively impaired and wheelchair-bound residents are especially vulnerable. In my parents’ experience, understaffing contributed to injuries from falls, long waits for assistance, inadequate toileting, pressure sores, dehydration, muscle contractions, limited help with meals, insufficient medical assessments and poor hygiene. During my father’s final days, he suffered greatly from the lack of staffing to provide good palliative care.

Understaffing affects nursing home employees by causing high turnover, low morale, fatigue and physical injuries. Poorly paid nursing assistants provide the most direct care, and demands placed upon them are often impossible to meet. In each facility I met compassionate, dedicated employees and appreciated their efforts under such challenging conditions.

Profit-driven corporations that own these institutions must be held accountable. The private-pay charge for a nursing home room is more than $5,000 a month. The charge for Medicaid residents is lower but still substantial. Yet, these facilities continue to be understaffed.

Our long-term care residents deserve better. If Indiana legislators fail to act, then we must demand reform at the federal level.

Please support The National Consumer Voice for Quality Long-Term Care, a non-profit organization to protect the rights, safety and dignity of America’s long-term care residents (www.theconsumervoice.org).

Andrew Sullivan at the Daily Beast blog published an article from Medical Billing and Coding called "Why Do Americans Pay More for Health Care?".  The United States has fallen behind other nations, failing to provide affordable health care to its citizens. Americans spend $477 billion a year MORE on health care than other advanced countries. So why do we pay so much compared to other wealthy nations?  The report was in two parts.  Part 1 and Part 2.  See graph.

Major reasons:  No price regulation, administrative waste and overhead, medical errors, and overpaid doctors.

No surprise but the comparisons to other industrialized nations is incredible.

Infections, the cause of nearly 400,000 U.S. nursing home deaths per year, may be largely the result of understaffing. Expert researchers at the University of Pittsburgh’s Graduate School of Public Health analyzed data collected for Medicare/Medicaid certification involving about 16,000 nursing homes per year and roughly 100,000 observations — representing 96 percent of all U.S. nursing home facilities.  The study, scheduled to be published in the May issue of the American Journal of Infection Control, found a strong correlation between low staffing levels and the receipt of an infection control deficiency citation.

Federal regulations including OBRA requires nursing homes to be certified before receiving reimbursement for Medicare and/or Medicaid residents and facilities that do not meet certain standards are issued deficiency citations. The researchers examined the deficiency citation for infection control requirements known as the F-Tag 441. Fifteen percent of U.S. nursing homes receive deficiency citations for infection control per year, the study says.

"Our analysis may provide some clues as to the reason for the persistent infection control problems in nursing homes," the study authors say. "Most significantly, the issue of staffing is very prominent in our findings; that is, nurse aides, LPNs and RNs, low staffing levels are associated with F-Tag 441 citations. With low-staffing levels, these caregivers are likely hurried and may skimp on infection control measures, such as hand hygiene."

This seems pretty obvious to me.  If you do not have sufficient well-trained staff, the quality of care will decrease.

Read More →

This year the first wave of Baby Boomers reach age 65, and we now face a rising tide of older adults that will double in size by 2030. Already beset with critical shortages of services to care for older adults, how will our nation and our health care system deal with the unique needs of this growing older adult population? Will we be able to adapt and create opportunities as we have done before?

The Eldercare Workforce Alliance (EWA) was formed to help policymakers, health care providers and family caregivers prepare to avert the impending crisis. EWA is comprised of 28 national organizations representing a wide range of professions, including physicians, nurses, direct-care workers, psychologists, pharmacists, social workers, physical therapists – as well as eldercare employers, family caregiver advocates, and consumers, united in our commitment to address the eldercare workforce shortage, in order to ensure that our parents and grandparents receive quality care.

Eldercare is projected to be the fastest-growing employment sector within the health care industry. Strengthening these professions and supporting family caregivers is not only vital to our social infrastructure and improving the quality of care, but also has the potential to drive long-term economic growth.

See facebook page here.

79.7% of uninsured patients seeking emergency care in four San Diego hospital ERs could have had some form of government insurance, but did not, according to research cited at health policy journal Health Affairs by the Foundation for Health Coverage Education (FHCE) (www.CoverageForAll.org).  The analysis shows that a significant issue facing the uninsured is not the availability of free and low-cost programs, but the poor communication and faulty application processes that need to be streamlined.  The American Hospital Association estimated hospitals lost $36.5 billion in uncompensated care due to underpayments for service by Medicaid in 2009.



The data was uncovered through an analysis of the FHCE’s Eligibility Survey results, which also found that 61.7% of national online respondents seeking to obtain coverage were likewise unaware that they were eligible for government coverage. .




Key findings:

 · 79.7% of patients were eligible for state and federal health coverage programs,

· 16.9 % were eligible for private coverage – this includes group coverage of 2 or more employees, individual coverage with medical underwriting, COBRA and Cal-COBRA,

· 3.3 % were eligible for high risk pool coverage – this includes California’s state-run high risk pool, Major Risk Medical Insurance Program, and the newly implemented Pre-Existing Condition Insurance Plan (PCIP).



Key findings of the Online Survey, which was given to web visitors from all 50 states and Washington D.C., include:

· 61.7 % of respondents were eligible for state or federal health coverage programs, most of which require individuals to have income of $44,700 or below for a family of 4 to qualify,

· 21.1 % were eligible for private coverage – this includes individual, group, or COBRA and MiniCOBRA,

· 15.4 % were eligible for high risk pool coverage – this includes state-run high risk pools, as well as the newly implemented Pre-Existing Condition Insurance Plan (PCIP).


The blog posting was written by four health care leaders, Leonard D. Schaeffer, Alain Enthoven, Ph.D., David S. Helwig, and Phil Lebherz, executive director of FHCE.


Based on the Eligibility Survey findings and analysis of the current application system, the authors suggest the best strategy for solving the dilemma is to use point-of-service enrollment. When a person without insurance seeks treatment, a trained staff member in any qualified health care setting could simply go to an online address, input basic patient data, check for available options, and promptly enroll the person in the relevant government health coverage program. Point-of-service enrollment would have automated check-points for eligibility and implement a transparent system with fraud controls. Through point-of-service enrollment, the government could significantly reduce a costly administrative system that drains resources.



The Foundation for Health Coverage Education is a non-profit organization with a mission to help simplify public and private health insurance eligibility information in order to help more people access coverage. The CoverageForAll.org website and U.S. Uninsured Help Line (800-234-1317) receive over 100,000 visitors or callers each month. For more information, visit www.CoverageForAll.org , friend us on Facebook or follow us on Twitter (@CoverageForAll).



Reuters had an article about a new study showing that two out of every five residents with urinary problems got inappropriate drugs which in turn increased their chance of getting a bacterial infection.  Doctors are only supposed to treat a UTI with antibiotics if the patient meets certain criteria.  Dosa said overuse can lead to drug-resistant bacteria and so increase the risk of hard-to-treat infections.

Over six months, one out of seven people that received UTI antibiotics in the nursing homes came down with Clostridium difficile, a bacterium in the digestive tract that can cause diarrhea, cramps and sometimes life-threatening inflammation of the colon.

Failing to keep residents clean with proper toileting and hygiene prevent most UTIs. UTIs occur when bacteria enters the urethra, then the bladder.  Untreated, they can cause kidney damage or infection, or in rare cases sepsis which is a life-threatening blood infection. According to the researchers, the disease is especially common in nursing homes, affecting nearly half the residents at some point during their stay.

To be treated with antibiotics, patients should have three out of five symptoms described in current UTI guidelines, such as a fever or a burning sensation while urinating.

SOURCE: Achives of Internal Medicine, online March 14, 2011.


Roxanne McAnn at NursingSchools.net sent me an interesting article "15 Interesting Facts About For-Profit Hospitals".  See below:

If you haven’t spent much time in the hospital, you’ve probably never thought about the difference between non-profit and for-profit facilities. Yet for those in the health care industry, and who have medical conditions that need constant care and the larger community, the difference between the two can be substantial. As a nurse or health care professional, these are issues that may affect how you practice, where you want to work and what kind of facilities are available where you live – so it’s important to know as much as you can. As many communities are divided between those who support and those who oppose for-profit health care, you’ll need to know the facts to make an informed decision. Here are some to get you started, letting you know the pros, cons and stats of for-profit hospitals.

Over 17 percent of hospitals are for-profit. In 2002, that number was only around 10%, demonstrating a marked growth in the for-profit health care industry over the past decade, growth that’s expected to continue over the next five years.
For-profit hospitals often focus on high-end, high-revenue treatments. Visit a for-profit hospital and you’re likely to see a gleaming cardiac wing, top-notch brain surgeons and fancy CT scanners. What you are less likely to see are family planning services, emergency rooms and psychiatric care. These services have a low rate of return on investment and may actually cost rather than bring in money, so many private institutions opt out of providing them. Of course, there are some for-profit hospitals that provide the bulk of these services (and others) to their local communities.
More for-profit hospitals engage in morally questionable practices like patient dumping. A study found that for-profits were twice as likely to dump emergency room patients onto other facilities as not-for-profits. Patients who do not have insurance or whose plans will not cover emergency care were more likely to be transferred, often in a manner that violates the Emergency Medical Treatment and Labor Act. Not-for-profits certainly aren’t in the clear here, but the difference between the two is striking.
For-profit hospitals are buying out may non-profits. In communities around the nation, many not-for-profit hospitals are struggling to stay afloat. Rising costs, a heavy patient load and outdated equipment make some simply not economically viable. For-profit medical groups are often stepping in and buying these hospitals. While some community leaders are relieved that the hospitals are being saved, others worry that it will be at a cost to the economically disadvantaged in the community. With more hospitals on the auction block every day, the effect of this change is likely to become clear in the coming months and years.
It’ll cost you more to go to a for-profit hospital. Not necessarily because they just want to charge you more, though profit margins certainly are an issue. For-profit hospitals don’t get the tax breaks that not-for-profits do, meaning they have to charge more to make up for it. How much? Expect to pay around 19% more for a visit to a for-profit than a not-for-profit.
For-profit hospitals have a higher death rate, on average. While the results of the study have been hotly contested, a group of Canadian researchers found that for-profit hospitals have a slightly higher death rate — around 2% higher. While the study found a difference, researchers were unable to pinpoint just what was causing the disparity, but some think it might have to do with for-profits cutting corners in order to generate more revenue. Of course, that number doesn’t mean every for-profit has a higher death rate — it is an average– some may have a much lower chance, while others are much higher.
A woman is 17 percent more likely to have a C-section at a for-profit hospital. While the number of C-sections performed nationwide at all hospitals has skyrocketed in the past decade, a fact many see as a direct threat to the safety of both women and their children, a California study found that women are even more likely to get a C-section at a for-profit hospital. The reason isn’t hard to figure out. A surgical birth costs twice as much as a vaginal one, and more C-sections means more profit. Additionally, once that baby is born, it’s more likely to end up in a pediatric ICU, whether it needs it or not, at a for-profit.
You’re more likely to get diagnosed with costly conditions at a for-profit. And that would be fine, provided that was really what was ailing you. A study in a German medical journal found that many for-profits may be guilty of up charging. They compared admissions of patients with respiratory infections and pneumonia, two conditions that can be pretty hard to tell apart from a medical standpoint, but with one usually paying about $2000 more to the hospital. Over the past decade, for-profits diagnosed the more expensive condition at rates much higher than that of not-for-profits. Lawsuits have since reduced this phenomena, but more recent data shows that for-profits still routinely cost Medicare more than their non-profit counterparts.
For-profit hospitals may have an advantage when it comes to efficiency. There is one area in which for-profits often excel. Because they’re watching the bottom line, for profits are better at reducing waste, streamlining their processes and running a more efficient, tightly managed facility. Of course, there are exceptions, and studies have found that it depends more heavily on ownership than on profit status whether or not a hospital will be efficient.
For-profit hospitals may stretch staff more thinly. Because they’re focused more operating efficiency, for-profits often have lower staffing ratios. This may not mean much for patients, as these staff members are usually compensate by being more productive (most patients often rate than standard of care similarly.) Yet it can make a difference in terms of stress and job satisfaction for those who are working in a for-profit institution. A study found that hospital workers are more likely to feel valued as a person, receive praise and feel their job is important at not-for-profits than at for-profits.
Dementia patients are more likely to be over treated at a for-profit. The practice of tube-feeding patients with advanced dementia has been widely criticized by the top medical journals and isn’t medically necessary in most cases, yet doctors are still using it as a treatment for dementia patients. While it occurs in for-profits and not-for-profits alike, patients at the former are 33% more likely to be given a feeding tube. It is even more common at large hospitals in either category, with a whopping 50% greater chance of feeding tube insertion in hospitals with over 300 beds.
Patients rate higher loyalty and satisfaction in for-profit ERs. While some for-profits might shy away from these low-return facilities, those who do have them tend to have higher rates of patient satisfaction than their not-for-profit counterparts. Some suggest that the reason for this may be due to for-profits having access to greater capital, meaning they can more easily invest in updated equipment and services. Additionally, not-for-profits are often chronically overburdened with patient volume and suffer from short staffing, factors that could reduce overall satisfaction
For-profit hospitals rate consistently lower when delivering care for these common conditions: congestive heart failure, heart attack and pneumonia. If you’ve got any of these conditions, or suspect you might, you may be better off heading to a not-for-profit if you have a choice. A 2006 study by the Harvard Medical School determined that patients with these conditions were more likely to get high-quality care diagnosis and treatment for these conditions as not-for-profits– a fact they suggest is due to increased staffing and more technology.
For-profit hospitals have lower costs per patient. Whether this is for better or worse for patients is up to you to decide, but Census data in 2008 recorded that the average total cost per patient per stay is about $7,985 at a for-profit hospital compared to $10,081 at a not-for-profit. This could be due to greater cost-cutting measures, efficiency or differences in staffing at for-profits versus their counterparts.
The impact of for-profit hospital conversion on the community is varied. Some may see for-profit hospitals taking over not-for-profits as a blessing, others as a curse, but the facts don’t have much to lend either side. Studies conducted by the Boston University School of Public Health found that some for-profits dramatically increased care to the poor while others decreased it, sometimes as much as 40%. The study found that, on average, there were no long-lasting changes in care between the two types of hospitals, meaning a lot of worries communities have about for-profit health care could be unfounded.




Ken Martin at NursingSchools.net sent me the following article about food poisoning. 

The CDC estimates that there are about 48 million illnesses caused by food poisoning each year, and as a health care professional you’re bound to see more than a few. Of course, knowing that food poisoning is a common occurrence isn’t any consolation to those suffering through the nausea, vomiting, abdominal cramps and digestive problems it can cause. Your best weapon against food poisoning is prevention, and there are a number of things you can do to reduce your risk of exposure to some of the common bacteria that cause it. Learn these common causes of food poisoning so you can eat smart and help stop yourself from becoming just another statistic.

1.  Raw or undercooked food. Whether you’re cooking at home or going out, eating food that hasn’t been cooked thoroughly or brought to the appropriate temperature can put you at high risk of developing food poisoning. While you might enjoy rare steak, runny eggs or certain raw veggies, these foods can all carry bacteria when they are not cooked long enough or hot enough to kill off the offending particles. Common bacteria found in undercooked food include E. coli, salmonella and campylobacter. Be safe instead of sorry and ask that your food be cooked through or use this chart when at home.

2.  Food that is not stored at the proper temperature. While simple common sense would tell you that leaving foods like meat and dairy products out of refrigeration makes them unfit to eat, temperature regulation can be a bit more complicated. Refrigerators can malfunction, foods can be forgotten on the counter and instructions on labels can be misread. To keep yourself safe, always check the temperature on your fridge and freezer. They should be at 40 degrees F and 0 degrees F respectively. Always read the label to see what foods will need be refrigerated immediately and which have to be cooled after opening. If you plan to freeze foods, do it within 2 days of purchase. This can help prevent some very serious bacteria from growing and making you sick.

3.  Letting food sit out.  Most of us are smart enough to not let refrigerated foods sit out, but sometimes we can forget to put away the leftovers or want it on hand at a party. In order to keep these foods safe to eat and avoid some common bacteria taking hold, you should always put leftovers away as soon as you can. If you’re serving food at a party, keep hot food at 140 degrees F or warmer, cold foods at 40 degrees F. Never leave perishable food out for more than two hours, especially if the weather is warm. This will help ensure that neither you nor your guests end up sick.
4.  Not washing hands before eating or preparing food. Contamination of foods from dirty hands is a big cause of many cases of food poisoning. Always wash your hands thoroughly before and after handling foods at home (for at least 20 seconds) and only eat at restaurants with strong showings in health department assessments. Additionally, always make sure your hands are clean before eating food as well, especially if you will be touching them. Without these precautions, you could put yourself at risk of coming in contact with bacteria like staphylococcus-aureus and clostridium-perfringens.
5.  Contamination of other foods by raw meat. Cross-contamination of foods is a major health issue and one that many out there should be highly conscious of avoiding at home. When juices from contaminated meat get onto cutting boards, hands and into the refrigerator, contamination can spread to other foods, some of which you might not plan to cook at all. It is essential to keep raw meat, poultry and fish separate from other foods. Always wash any utensils, countertops and cutting boards that have come in contact with them immediately, sanitizing them with bleach and water, or even having separate tools for handling meat can be a big help.
6.  Eating raw shellfish. Raw oysters may be a delicacy, but ingesting them doesn’t come without some serious risks. Oysters from the Gulf of Mexico are commonly contaminated with Vibrio vulnificus bacteria which can cause mild to serious food poisoning. Additionally, even oysters that do not come from this region are often left unrefrigerated for several hours while being brought to shore. While you may be fine after eating raw oysters, be aware that ingestion of these shellfish uncooked is a big risk and could lead to serious health issues.
7.  Improper canning. Canning foods at home has been a common practice for several decades, but it’s one that needs to be carefully monitored in order to ensure that the food being preserved won’t carry contaminates along with it. Botulism is perhaps the most common bacteria contaminant in improperly canned food, and is one of the most serious and potentially deadly forms of food poisoning out there. Always boil jars and lids to be used in canning to kill off any lingering bacteria and make sure that all cans are properly sealed. Improper canning can also happen with foods you get off grocery store shelves so look out for bulges, discolored food, or

8.  Ingesting expired food. We’ve all done it at one point or another, but eating expired food comes with a big risk for food poisoning attached. Always check expiration dates before ingesting any food in your home or purchased at the store. If there is no date on the package, no packaging or only a sell by date, use the government guidelines for cold storage to help you determine if a food is safe to eat or not.
9.  Not reheating food thoroughly. You might think that you only have to worry about food poisoning in foods that haven’t already been cooked, but that’s not entirely the case. You should also be careful with foods that you’re reheating, especially if they’ve been hanging out in your fridge for more than a couple of days. When reheating foods, make sure that meats reach a temp of at least 160-170 degrees F and that other foods come to around 165 degrees F. This will ensure that any bacteria that might have made its way into the food will be killed off and that you’ll be able to avoid a common cause of food poisoning.
10.  Not washing produce thoroughly before preparation. Even those seemingly innocuous veggies can be the source of food poisoning if not washed and prepared properly. Prior to reaching your table, there’s no telling how many things they may have come in contact with, so always clean any fruit or vegetables with a soft kitchen brush and water (or a pre-prepared veggie wash) to ensure that any bacteria it contains will be largely washed away. This is especially important with foods that you do not plan to cook. While foodbourne illness is more commonly caused by meats, recent outbreaks of salmonella and E. coli have originated in spinach and tomatoes.
11.  Unclean cooking utensils and surfaces. When it comes to food safety, cleanliness matters. Dirty kitchens attract mice and rats that can spread disease and also create ideal places for bacteria to grow and thrive and access your food. It’s essential to keep any space you plan to cook in and any tools you plan to use highly sanitized. The USDA advises putting a tablespoon of bleach into one gallon of water to create a sanitizing liquid. This can help prevent any bacteria hanging out in your kitchen from getting on food and will ensure that none are able to cross contaminate one another.
12.  Unpasteurized foods. For the most part, people are fine after eating foods that are unpasteurized, provided they have been stored and served in a safe manner. Yet for those with compromised immune systems, who are pregnant and the very young and very old could be at risk for food poisoning from these. Commonly pasteurized foods include milk, cheeses, yogurt, ice cream, ciders and juices. Unpasteurized versions of these foods can carry Salmonella, E. coli, and Listeria, which can make individuals very sick.

There’s been a lot of analysis of the disastrous impact of the Supreme Court’s 5 to 4 Concepcion v. AT&T decision which allows corporations to ban class actions with hidden mandatory arbitration clauses. The Court ruled that the Federal Arbitration Act barred states from protecting their own residents from these horrendous arbitration clauses. Andrew Cohen at The Atlantic put it this way:

"Suffice it to say that the Court’s decision completely defies the very federalism principles which are so often articulated by the very conservative members who agreed Wednesday to strike down a state’s effort to level the consumer playing field for millions of its residents. This is as big a pro-business, pro-corporate ruling as we’ve ever seen from the Roberts’ Court — and it will take explicit Congressional action to overturn it."

Congress doesn’t have a great track record on that score.  However, Senator Franken is taking the lead with Richard Blumenthal (D-Conn.) and Rep. Hank Johnson (D-Ga.) by introducing legislation that would restore consumers’ rights to seek justice in the courts. Their bill, called the Arbitration Fairness Act, would eliminate forced arbitration clauses in employment, consumer, and civil rights cases, and would allow consumers and workers to choose arbitration after a dispute occurred.


Several media outlets have reported the labor and health issues at a Sava Senior Care facility in Baltimore.  Nursing and other staff at Summit Park Health and Rehab Center were objecting to unsafe working conditions.  SAVA has failed to negotiate a working wage and share information about asbestos in the building.  They were recently notified of dangerous asbestos in the building.  According to the Centers for Disease Control, asbestos, which can often be found in insulation and fireproofing materials, may lead to life-threatening diseases, including lung cancer, to those exposed to it.   Sava knew about the asbestos. Asbestos is now finally being removed.

At the same time, Employees have been working without a raise for the last year and that the company has understaffed causing serious health consequences.  "You shouldn’t have to put a price on resident care," said Randallstown resident Donta Marshall, a nurse’s aide at the facility. "At the end of the day the residents suffer."

It’s all about the proftis.

Sally Hill, a Catonsville resident who has worked the at the company for 38 years, said the company is losing good staff because the pay is not competitive. "It used to be family owned," she said. "It’s not the same anymore."

It’s all about the profits.

Rose Ludwig has worked at the center on for seven years. “The cost of gas and electric has gone up. We’ve gone over a year without a raise.”

It’s all about the profits.