Critics are blaming budget cuts and incompetence on the backlog of Missouri Medicaid patients waiting for answers about in-home care.  The state’s top public health official told legislators she doesn’t know how many state Medicaid patients are waiting for answers about in-home care.  SynCare LLC, the Indiana company the state had hired to assess what in-home care those Medicaid patients should receive was not doing a good job. SynCare’s contract was canceled Aug. 31.  SynCare’s contract was worth up to $5.5 million. The company had agreed to screen more than 50,000 Medicaid recipients.

Health providers have said there are hundreds of Medicaid patients who are waiting, some of whom have literally died while waiting to be assessed. The delays have meant that some patients who are infirm enough that they qualify for admission to a nursing home are doing without care. Others are depending on relatives or friends.

Once SynCare was hired, about four dozen state health employees lost their jobs. The state will need at least 120 employees to handle the backlog. Officials have not decided if they will seek another firm to handle the program.  Why would they do that?  Why add a profit motive?


The New York Times had an interesting article about the costs of health care and doctor’s compensation.  "Doctors are paid higher fees in the United States than in several other countries, and this is a major factor in the nation’s higher overall cost of health care, says a new study by two Columbia University professors."

“American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United Kingdom,” said the study, by Sherry A. Glied, an assistant secretary of health and human services, and Miriam J. Laugesen, an assistant professor of health policy at Columbia.

The study, being published in the journal Health Affairs, found that the incomes of primary care doctors and orthopedic surgeons were substantially higher in the United States than in other countries. Moreover, it said, the difference results mainly from higher fees, not from higher costs of the doctors’ medical practice, a larger number or volume of services or higher medical school tuition. Such higher fees are driving the higher spending on doctors’ services, the study concluded.



USA Today had a great article on Medicare premiums.  Medicare Advantage premiums fell 4%while enrollment rose 10% this year, despite predictions from opponents of last year’s federal health care law that it would drive down enrollment and force up premiums.  Extra benefits in some Medicare Advantage plans, such as for vision or hearing, also are expected to remain the same.

The new statistics disprove the doom-and-gloom predictions of last year and show that because of the 2010 law,  Medicare Advantage premiums will go down next year and seniors will enjoy more free benefits and cheaper prescription drugs.

Medicare Advantage allows seniors to leave traditional Medicare and choose private health insurance plans, including health maintenance organizations or preferred provider organizations.

The health care law includes $145 billion in reduced payments to Medicare Advantage providers over 10 years. Critics said lower payments would force insurance companies to increase premiums, and that fewer people would enroll. The CBO predicted that by 2019, Medicare Advantage enrollment would decline by 35% because of a continued reduction in payments to providers.  

The critics were dead wrong.

The plans were targeted because the government pays more per capita for beneficiaries in the private plans than it spends on those in traditional Medicare. The billions of dollars cut from the plans were used to help the Obama administration pay for the cost of expanding coverage to 32 million Americans through expanded Medicaid eligibility and subsidies for people buying coverage in new insurance exchanges starting in 2014.



The Philadelphia Inquirer had an editorial from Stuart Shapiro about Medicaid reimbursements.  Stuart H. Shapiro is president and CEO of the Pennsylvania Health Care Association and Center for Assisted Living Management, a lobbying front for nursing home owners.  He uses fear and exploitation of the "Greatest Generation" to make his point:  Nursing homes want more money.

"For years in Pennsylvania and across the country, Medicaid reimbursements have fallen far short of covering the true cost of care for nursing-home residents. But nursing homes were able to weather the losses because their Medicare payments for short-term rehabilitation patients countered their Medicaid losses for long-term care residents. But now with Medicare under attack, the landscape has dramatically changed. For older Pennsylvanians and their families, access to nursing home care and the quality of that care is very much at risk."

"The message is clear: Any further cuts at the federal or state level to Medicare or Medicaid threaten an already fragile long-term care system with unthinkable and tragic results. Further cuts would place quality of care at risk and very soon limit access to people who need nursing-home care."

The problem is that increased reimbursement levels do not go to staffing and training but is added to the profit margin.  Increasing the reimbursement rate won’t increase the quality of the care.


Older individuals’ complaints about memory lapses such as having trouble remembering recent events may indicate that they are experiencing cognitive problems that are greater than typical age-related changes. These findings, which are published in the Journal of the American Geriatrics Society, indicate that primary care clinicians, who are often the first to see patients who are worried about their memory, should be aware that such complaints might be indicative of something serious and warrant a further cognitive assessment.

Because the number of U.S. adults aged 65 years and older is projected to nearly double over the next two decades, the incidence of Alzheimer’s disease and other dementias is also expected to rise. In response, clinicians are incorporating cognitive screening tests as part of annual wellness visits for older people, and researchers are looking for simple ways to identify older individuals who may benefit from additional cognitive evaluations.

To see if certain memory complaints might be linked with potentially serious problems related to memory and thinking, investigators telephoned 16,964 older women (average age of 74 years) and asked them seven questions related to memory complaints, followed by various questions that assessed cognitive function.

Investigators found that, in general, the more memory complaints older individuals have, the worse off their cognitive functioning is. However, not all complaints are related to cognitive decline. For example, a “yes” answer to the question “Do you have much more trouble remembering things from one second to the next?” did not relate to cognitive impairment but was associated with normal aging. By contrast, a “yes” to the question “Do you have trouble finding your way around familiar streets?” was highly associated with cognitive impairment.

“These findings suggest that clinicians may need to differentiate between the types of memory complaints their patients have, as some are likely due to normal aging whereas others are worrisome for possible cognitive decline,” said Dr. Rebecca Amariglio of Brigham and Women’s Hospital and Harvard Medical School, one of the study authors.

This will be particularly important as the incidence of Alzheimer’s disease increases and therapies for the disease become available.

This study is published in the September issue of the Journal of the American Geriatrics Society. Media wishing to receive a PDF of this article may contact
Full citation: Specific Subjective Memory Complaints in Older Persons May Indicate Poor Cognitive Function. Journal of the American Geriatrics Society, 2011; DOI: 10.1111/j.1532-5415.2011.03543.x
URL upon Publication:

About the Author: Rebecca England Amariglio is a neuropsychologist at Brigham and Women’s Hospital and Harvard Medical School with research interests in the early detection of Alzheimer’s disease.


A federal trustee overseeing the bankruptcy of a company that operates two facilities wants the court to liquidate the business after an inspection revealed "gross mismanagement" at both locations.  Gregory Schiller, the U.S. trustee in the Chapter 11 bankruptcy of Scranton-based New Hope Personal Care Homes Inc., recently filed a motion to convert the case to Chapter 7 liquidation. The company operates Pennswood Manor on Cedar Avenue in Scranton and Mountainside Manor in Dallas, Pa.

A state official’s inspection revealed the presence of bed bugs and addiction-treatment patients preparing meals for residents at Pennswood Manor and an infestation of flies and a patient afflicted with an infectious skin ailment at Mountainside Manor.

"…The quality of patient care being provided to the residents of these facilities falls well below acceptable standards," wrote Mr. Schiller, who supervises administrative aspects of the bankruptcy case. "…The debtor’s failure to properly operate these facilities and provide an acceptable level of care to their residents constitutes gross mismanagement …"

A report says the first floor of Pennswood Manor had been converted to a drug- and alcohol-rehabilitation unit and she was concerned because those patients had access to residential patients on the second floor. Inspectors discovered a bedbug infestation at Pennswood, Ms. Gonzalez wrote, that had existed for months, and there was a shortage of toilet paper and paper towels.

See article at The Times-Tribune.



Nursing homes have a fiduciary relationship to nursing home residents.  By law, these are vulnerable adults.  Recently a national debate was ignited following Fundamental Long Term Care’s decision to evict two married residents who wanted to die in peace and dignity.  They had to leave the facility to die.  The New York Times had an interesting article on the issue.  Below are some excerpts:

Armond and Dorothy Rudolph had a mutual horror of a lingering decline in their final years. They’d joined an organization that supports the right to end life when illness or pain becomes overwhelming; they’d attended meetings and given both their children literature on the subject. They’d drafted advance directives.  As it happened, the elder Rudolphs had a long and satisfying old age in Albuquerque, N.M., where they lived for 60 years; they gardened and volunteered with the Boy Scouts and served as leaders in their Presbyterian church. When their large house and gardens became difficult to maintain, they built a smaller one in a neighboring town, then moved again to a retirement community.

In October, they entered an assisted living facility called The Village at Alameda, thinking it would be their last home. Both showed symptoms of early dementia. So in January, they set in motion their plan to stop eating and drinking.  The facility tried to evict the couple. The administrators, apparently on orders from the corporate legal department in Sparks, Maryland, told the family the Rudolphs had to leave the next day.

Their son Neil Rudolph protested that the couple — already on Day 4 of their fast — had nowhere to go. He also pointed out that their contract required 30 days’ notice of discharge. The following day, administrators called 911, reported a suicide attempt and told the paramedics to take the elder Rudolphs to a hospital.

So much for the peaceful passage.

Shortly thereafter, two emergency squads, from the Albuquerque Fire Department and Albuquerque Ambulance Services, converged on the scene. Neil Rudolph’s wife called a reporter from The Albuquerque Journal, to whom the elder Rudolphs gave outraged and lucid interviews. The emergency crews soon called a doctor at the University of New Mexico’s emergency medicine department, part of a consortium that consults when a 911 call brings a situation outside the norm — and this certainly qualified.

Reassured that they understood the ramifications of their decision.  The Rudolphs signed papers showing they had declined transport.  Their children transferred the Rudolphs to a rented house in Albuquerque and moved in themselves.  Neil Rudoplh has launched a campaign with Compassion & Choices to inform people about voluntarily stopping eating and drinking. The organization is circulating a rider to assisted living contracts that states, in part, “Facility will respect Resident’s end-of-life choices and will not impede any course of treatment, or non-treatment, freely and rationally chosen by Resident.”

Melissa Trenway writes articles for, a website dedicated to providing students with the information and tools needed in order to pursue their BSN to MSN.  She wanted us to share her latest article she posted called A Complete Guide to Transferring Your Nursing License to Another State.


"Those with a nursing license who wish to move to another state have options available to them. While states differ on what is required of nurses, those who have graduated from an accredited nursing program can find that transferring a license is not as difficult as getting one."

WHIO in Dayton, Ohio reported the guilty plea and sentence of Kevin Burns, a nursing home employee who pled guilty to raping an elderly woman at a nursing home.

Burns pleaded guilty to one count of rape as part of a deal reached with prosecutors.  He was sentenced to nine years. In the courtroom, Burns said he struggled with an addiction to pornography while he worked at the Friend’s Care Nursing Home in Yellow Springs.

After Burns serves his time, he will have to spend 5 years on probation and register as a Tier 3 Sex Offender, the strictest classification. had an article about Eufemia Fe Salomon-Flores, an administrator at Glen Island Center for Nursing and Rehabilitation, who admitted to defrauding Medicaid out of $2.2 million and failing to pay taxes on two health care companies she created. Salomon-Flores pleaded guilty in Westchester County Court to second-degree grand larceny and third-degree criminal tax fraud, felonies.

"Our cash-strapped state and Medicaid program cannot afford fraud, and my office will continue to hold accountable those who rip off taxpayers," Attorney General Eric Schneiderman said in a statement.

She was charged with submitting inflated claims in quarterly reports to the state Health Department from April 2002 to November 2006. She exaggerated the diagnoses and conditions of patients at Glen Island Center, and lied about treatment they received so the nursing home would get larger Medicaid reimbursements.

Salomon-Flores also failed to pay taxes on money she received as the founder of Premier Health Care Staffing and Phil Am Health Care Professionals, companies the attorney general’s office described as "bogus." In 2008 alone, the companies took in more than $307,000, giving Salomon-Flores a tax liability of more than $31,000.