MCknight’s had an article about the recent study from Researchers at Winthrop University Hospital in New York that showed living at a nursing home may be a predictor of whether a hospital patient dies from Clostridium difficile.  Researchers looked at 254 patients with C. difficile infection with a goal of creating an "on admission" prediction model. They found that nursing home residents were more likely to die from complications related to the disease when compared to those who had community-acquired C.diff.   After controlling for the risk attributable to co-morbidity, nursing home residence still remains a strong predictor of mortality. In fact, the study showed the risk for CDI-related death could almost triple for an admission from an institution compared to one from the community.

The nation’s 90-and-older population nearly tripled over the past three decades, reaching 1.9 million in 2010, according to a report released by the U.S. Census Bureau and supported by the National Institute on Aging. Over the next four decades, this population is projected to more than quadruple.

Because of increases in life expectancy at older ages, people 90 and older now comprise 4.7 percent of the older population (age 65 and older), as compared with only 2.8 percent in 1980. By 2050, this share is likely to reach 10 percent.

An older person’s likelihood of living in a nursing home increases sharply with age. While about only 1 percent of people in their upper 60s and 3 percent in their upper 70s were nursing home residents, the proportion rose to about 20 percent for those in their lower 90s, more than 30 percent for people in their upper 90s, and nearly 40 percent for centenarians.


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USA Today reported on the recent Inspector General’s report that concluded Medicare inspectors "must do a better job of tracking reports of serious mistakes in care at the nation’s hospitals, as well as of informing rating agencies of the errors."

Hundreds of admittedly serious errors go unrecorded because the inspectors who find problems at hospitals don’t tell the national agencies that accredit hospitals. No one tracks the effectiveness of policy changes or how the hospitals actually correct mistakes. That means that those hospitals continue to participate in Medicare and that they don’t learn from their mistakes.

"Last year, the inspector general found that 15,000 Medicare patients die each month in part because of the treatment they receive in a hospital" including preventable negligence such as surgical fires, patient suicides, sexual assault, surgeries performed on the wrong patients and medical instruments left inside a patient after a surgery.

State survey and certification agencies check complaints and are supposed to report them to the Centers for Medicare and Medicaid Services (CMS). That should lead to a review to determine whether the hospital has fixed the problem and will still be allowed to work with Medicare.  However, the report shows, CMS regional offices notified hospital accreditors of only 28 of the 88 sampled immediate jeopardy complaints.

The Inspector General recommends the following reasonable steps:

•CMS should evaluate compliance with quality-assurance measurements.

•State agencies should monitor hospitals’ improvements.

•CMS should make it clear that state agencies tell hospitals what mistakes they’ve made.

•CMS should notify accreditors when hospitals make mistakes.


"If a 747 jetliner crashed every day, killing all 500 people aboard, there would be a national uproar over aviation safety and an all-out mobilization to fix the problem." However, "in the nation’s
hospitals…about the same number of people die on average every day from medical ‘adverse events,’ many of them preventable errors, such as infections or incorrect medications. Where’s the outrage?" USA TODAY Editorial 11/19/10

In November 2010, the U.S. Department of Health and Human Services issued a study that covered just the 15 percent of the U.S. population enrolled in Medicare. It found that each month one out of seven Medicare hospital patients is injured—and an estimated 15,000 are
killed—by harmful medical practice. Treating the consequences of medical errors cost Medicare a full $324 million in October 2008 alone, or 3.5 percent of all Medicare expenditures for inpatient care. Another recent study looked at the incidence of avoidable medical errors across the entire population and concluded that they affected 1.5 million people and cost the U.S. economy $19.5 billion in 2008. The Centers for Disease Control and Prevention have estimated that almost 100,000 Americans now die from hospital-acquired infections alone, and that most of these are preventable. Washington Monthly – March, 2011


Christine Seivers recently published an article “10 Frightening Facts About Prescription Pain Pills” that dovetails well with our audience.  She has asked me to share it.

"Prescription pain pills have changed the face of medicine in many good and bad ways. These powerful pills have helped many people manage their pain and increase their quality of life, yet the fact remains that painkillers have taken thousands of lives and are one of the most commonly abused and dangerous substances in the country. The rising mortality rates from prescription drug overdoses have now exceeded traffic fatalities, resulting in at least 37,485 deaths in 2009. This statistic is just one of many startling facts about prescription pain pills and the national epidemic they’ve caused. Here are 10 frightening facts about prescription pain pills:

Prescription drug abuse kills more people than traffic accidents
A recent study by the Journal of the American Medical Association said that people who are prescribed high doses of prescription pills may have a greater risk of death. In fact, drug overdoses and brain damage from long-term drug abuse killed an estimated 37,485 people in 2009, which surpassed the death toll from traffic accidents by 1,201 people. This alarming number of deaths is expected to rise, according to the U.S. Centers for Disease Control and Prevention.

Between 1998 and 2008, treatment admissions for prescription painkiller dependence grew 400%
Drug treatment admission rates have risen dramatically over the last decade, specifically for prescription pain med dependence. According to the Substance Abuse and Mental Health Services Administration, the treatment admission rate for opiates other than heroin grew 400% in 2008, which was up from 2005. This means that for every 100,000 population, 45 people aged 12 and older have sought treatment for their prescription pain med abuse.

Sixty percent of teens who abused prescription pain pills tried them before the age of 15
Teens and young adults abuse prescription drugs more than any other illicit drug, except marijuana. According to the United State Drug Enforcement Agency (DEA), one in seven teenagers admits to abusing prescription drugs for non-medical purposes, and 60% of the teens who abused prescription pain pills experimented before the age of 15.

Seven in 10 people who abuse prescription pain pills obtained them from a friend or relative
According to the Substance Abuse and Mental Health Services Administration, a staggering number of people obtain their prescription pain meds from a friend or relative for free. Seven in 10 people got their prescription painkillers from a friend or relative, whereas nearly 10% bought them from a friend or relative, and five percent took them from these people without asking.

About 120,000 Americans are hospitalized each year for overdosing on opioid painkillers
Prescription pain pill addiction has killed thousands of Americans each year. About 120,000 Americans go to the emergency room each year for overdosing on opioid painkillers. Prescription pain pill abusers can easily overdose if they take higher doses than directed, combine drugs, or use them with alcohol.


Prescription painkillers are the leading cause of fatal overdoses
Prescription painkillers cause more overdose deaths than street drugs like heroin, cocaine, and amphetamines, according to the Centers for Disease Control and Prevention. In the past, most overdoses were caused by illegal narcotics and took place in big U.S. cities. However, the number of deaths from opioid painkiller overdoses has more than tripled from 1999 to 2006, resulting in 13,800 deaths.

Opiod painkillers have increased the number of unintentional drug poisoning deaths in the United States
The rate of unintentional drug overdose deaths in the United States have risen tremendously between 1999 and 2007. During that time, more than 28,000 people died from unintentional drug poisoning. This alarming number has been attributed to the increase in both legal and illicit prescription opioid painkiller usage.

Three in 10 teens think prescription pain killers are not addictive
A large majority of teenagers believe that prescriptions pain relievers are not addictive and "much safer" than illegal drugs. Additionally, 56% of teens think prescription drugs are easier to obtain than street drugs. Teens can easily access prescription pain pills from their family members or friends, and they justify taking the pills because a doctor prescribes them.

Prescription pain pills are the second most commonly abused drug among teens
As stated above, a high percentage of teenagers think that prescription pain pills are not addictive and less harmful than street drugs, which explains why teenagers abuse this drug more than any illicit drug, except marijuana. Prescription pain meds are the second most commonly abused drug by teens, and they are the most widely misused type of prescription drug overall.

Prescription pain pill abuse and overdose death rates are highest in rural America
Although prescription drug abuse is rampant throughout the United States, the highest rate of prescription opioid abuse and fatal poisoning occurs predominantly in rural states within the Appalachian and Southwest region. Kentucky, Ohio, Tennessee, West Virginia, and neighboring states are some of the most troubled areas for prescription pain pill abuse.


The Palm Beach Post had an article about a former employee of Boca Raton Regional Hospital that has accused the hospital of cheating Medicare of at least $2 million.  Jeannette Lavoie claims hospital administrators intentionally used the wrong billing code to collect far more federal money for treating patients with heart problems than regulations allow. 

Don Boswell is representing Lavoie in the lawsuit she filed under the False Claims Act, which allows citizens to sue to recover money for the government.

Under the act, if the claims are correct, the hospital could be forced to pay three times the amount it overbilled Medicare. Lavoie was director of case management at the hospital when she became concerned that the health care facility wasn’t properly reporting whether patients who received pacemakers, cardiac stents, angioplasties or other heart procedures were being treated on an inpatient or outpatient basis. In a random review of 30 patient charts, the department found 27 errors.  Hospital administrators expressed confidence auditors wouldn’t uncover the mistakes.


The Washington Post reported millions of taxpayer Medicare dollars are going to contractors using inaccurate, inconsistent, and fraudulent data that makes it difficult to catch false bills submitted by corporate crooks, according to a recent inspector general’s report.  "Medicare’s contractor system has morphed into a complicated labyrinth, with one set of contractors paying claims and another combing through those claims in an effort to stop an estimated $60 billion a year in fraud."   The U.S. Department of Health and Human Services inspector general’s report found repeated problems among the fraud contractors over a decade and systemic failures by federal health officials to adequately supervise them.

The same issues were identified 10 years ago by inspector general investigators, and dozens of reports in the past decade also have found problems. In 2001, acting Inspector General Michael Mangano testified that the Centers for Medicare and Medicaid Services wasn’t doing a good job of holding contractors accountable.


The Mansfield News Journal had an interesting article on how Medicaid cuts in Ohio will affect staffing and thus the qualit of care provided to the most vulnerable among us. Nursing homes across Ohio have fired hundreds of staff after the state reduced Medicaid reimbursements to facilities on July 1.   Other chains have cut workers’ pay, as well as freezing or cutting benefits to insure profits.  Exactly how many nursing home jobs have been cut since the change in reimbursement rates isn’t certain. A survey by the two trade groups for the state’s for-profit nursing homes found 2,800 jobs lost at 333 facilities (roughly a third of the statewide total) since July. The survey by the Ohio Health Care Association and the Academy of Senior Health Sciences said about 80 percent of the 2,800 dismissed workers provided direct care to residents.

Complaints have increased including a jump in the most serious kinds of violations during the third quarter.  Republican politicians passed the reimbursement cuts in the state budget to "rebalance" the amount of money spent on seniors and people with disabilities.

Robert Applebaum, director of the Ohio Long-Term Care Research Project at Miami University’s Scripps Gerontology Center. "Research has shown … that more staffing results in better quality."


The Springfield News Sun reported the budget problems that some corporate nursing home chains are having after recent correction in Medicare reimbursements.  The people who will suffer to protect corporate profit margins will be residents and direct care workers.  On Oct. 1, the federal government started paying nursing homes about 11 percent less than they had been paying the previous year. Medicare typically pays in the neighborhood of $500 per patient per day, depending on the patient’s condition.  Nursing homes have cut back management hours or adminstrative staff but not workers that directly interact with patients. 
"The federal government has trouble figuring out what to pay for long-term care. The agency that
determines how much Medicare pays nursing facilities maintains the 11 percent decrease was
because it had overpaid nursing homes by more than 12 percent the year before."

The nursing home industry is pushing propaganda spouting that this new rule will result in 20,000 nursing home layoffs nationwide and another 20,000 jobs lost to abandoned expansion activity, according to results of a new national survey conducted by Avalere Health and industry lobbyists the Alliance for Quality Nursing Home Care.  The survey asked respondents if they planned to lay off direct service staff as a result of the new rule; whether facilities expected to postpone or cancel hiring; if they had to cancel planned facility expansions and acquisitions; and whether they were considering freezing or lowering wage rates.

According to the survey results, 38.6% of survey respondents said “yes” when asked if they
planned to lay off direct service staff such as registered nurses, licensed practical nurses and
certified nursing assistants. Forty percent affirmed that they would have to lay off corporate
and/or non-direct service staff.