We’ve published several blogs about pet ownership over the years. Pets have earned a place in our hearts as loyal companions, and dogs specifically have earned the place of man’s best friend. Most people have or have had a pet, and most people (95%) see their pets as family.

Having someone or something to care for can be very beneficial to people, elderly included. That’s in addition to the biological reactions we have to pets (interaction with dogs has been shown to increase feel-good responses in your brain such as endorphins and dopamine, for example).

For more in-depth research into why dogs are good for our mental health, check out this article from dogOwner.

The Des Moines Register reported The Centers for Medicare and Medicaid Services refusal to approve Iowa’s so-called “supplemental  payment plan,” a proposal formalized by lawmakers in 2016 without discussion or debate. The plan was just a sleazy windfall for the nursing home industry in Iowa.  Iowa politicians attempted to funnel already scarce Medicaid dollars to privately owned nursing homes that don’t need the money.  Over five years, the plan would have provided 410 nursing homes with an estimated $1 billion in additional taxpayer money. These include homes owned and operated by large, out-of-state, for-profit corporations. Many would have seen their revenue from Medicaid doubled.

The law was written entirely by industry lobbyists, according to Rep. Dave Heaton, R-Mount Pleasant, the bill’s lead sponsor in the Iowa House. It enables county hospitals to hold the licenses of for-profit, independent nursing homes to create the appearance — on paper at least — that the homes are managed by the hospitals.  This hospital “affiliation” would qualify the nursing homes for higher Medicaid payments than they’re currently entitled to collect as independent operators.

For two years, former Gov. Terry Branstad’s privatization of Medicaid has resulted in the loss of care for Iowans and the closing of health facilities. Elected officials at the state and federal level have repeatedly talked about the need to rein in spending on the health insurance program. The last thing public health care dollars should be used for is padding the bottom lines of for-profit nursing homes.

Fox4KC reported on the new Missouri law that requires nursing and other group homes to report sexual assaults to law enforcement. Current law only required reporting to the state agencies involved.  The mandatory reporting requirement for long-term care facilities will prevent cover-ups and increase the quality of supervision by the regulatory agencies.

This law was a result of a sad and tragic story.  Margaret (not her real name) was raped in her Missouri nursing home and died one day later. The facility notified the state but mistakenly thought the Russell family had called police. In fact, the family believed the home had called police, too.  By the time they were notified, detectives said the evidence was no good and no one was ever arrested in the death of the 93 -year-old woman.

“We applaud the Missouri legislature for passing this critical piece of legislation that will provide important protections to long-term care residents,” said Lynn Faunda Donovan, executive director of VOYCE, a long-term care ombudsman program for 21 Missouri counties.

In a statement, the group noted that between 1995 and 2016, there were 128 known cases of elder sexual abuse and assault with only 20 ending in convictions.

VOYCE and Russell believe mandatory reporting will help law enforcement investigate cases before they go cold.

 

ABC reported the horrific neglect suffered by Val Simpson, a nursing home resident at The Tinonee Gardens The Multicultural Village, because of cost-cutting and under-staffing in the facility.  To the facility’s credit, it has acknowledged it failed Simpson, who was in its care before she died last year.  The Australian Aged Care Quality Agency said the home’s failures at the time placed, or may have placed, the safety, health or well-being of residents at risk.

Ms Simpson’s daughter Sharon Dodd said remembering her mother’s last days was almost too hard to bear.  “Just the level of neglect and watching mum being in a bed of urine and faeces … the placement certainly didn’t provide her with the care she deserved,” Ms Dodd said.  Staff at Tinonee have told the ABC incontinence pads were limited to three residents per day and nappy rash cream always needed to be on hand.

Ms Simpson’s lack of oral care was also upsetting. Her mouth was at times dry, cracked and shrivelled with filth.

A close-up of an old woman's dehydrated mouth.
“It was really shrivelled up and she had lots of things that looked like warts on her tongue,” Ms Dodd said.  “She could hardly respond to me because her mouth was so dry.”

Her granddaughter, Kelsey Moss said she had been horrified by what she had seen.  “There was food left in her mouth and she was left to try and swallow on her own … the outcome could have been much worse,” Ms Moss said.  “She was thirsty, wanting to go to the toilet, never hungry, but definitely neglected there.”

Ms Dodd said her mother had been in so much agony, staff put her behaviour down to anger management problems, before giving her a sedative.  “If they knew anything about UTIs and how they change your personality, they would have known she had a UTI, instead of the anger issues,” she said.

Simpson also suffered regular falls while she was at Tinonee, which left her family concerned about unexplained bruising.

She also went missing one cold winter’s night, and was discovered hours later on all fours, disoriented in the home’s garbage collection area.

“It wasn’t until the kitchen staff came out and put the garbage away that they knew Mum was out there, not even knowing how to stand up,” Ms Dodd said.

 

 

WRAL News has learned the state is investigating allegations of abuse at Universal Healthcare North Raleigh nursing home that wee caught on video.  Rebecca Knapton, the patient’s daughter installed a hidden camera after her father complained about how he was being treated.

Knapton contacted WRAL News after seeing the video that was captured in her father’s room. According to the facility, staff members have been fired, but that doesn’t make the video any easier to stomach.

The video starts at about 4:20 a.m., when Knapton’s 68-year-old father, who is recovering from a stroke, slips off the bed. The volume on the TV is loud, but he can be heard calling for the nurses over and over.  He is on the floor for more than an hour before someone walks in at 5:25 a.m. She looks over the bed and walks out without speaking or checking on the patient.

The patient continues to call out for help.  It takes another 15 minutes for staff members to return. Instead of helping him, they start questioning him.

“What are you doing there,” a staff member says. “What are you doing on the floor?”

“I need help,” Knapton’s father replies.

The patient tells the staff that he had to go to the bathroom, but had an accident while waiting. The staff proceeds to change him on the floor, even though he repeatedly tells them he’s cold.

You were on the bed. You decided to go on the floor, so don’t complain that it’s cold,” a staff member says.

The same staff member even faults the patient for having a stroke.  “You had to do something very wrong with your life. What did you do? You’re suffering so bad, so you’ve done something wrong. Yes, you did,” the staff member says.

At around 5:40 a.m., after nearly two hours on the floor, the nurses finally lift Knapton’s father into the bed, but the berating continues.

“How old are you, one? You’re supposed to be enjoying your retirement. Instead, look what you are doing, pooping on yourself. Shame on you,” a staff member says.

The shaming continues as a staff member pulls the pillow from under his head, and with it more of the patient’s dignity.

“Shame on you. Shame on you,” the staff member says.

Choice Health Management Services, the parent company of Universal Healthcare North Raleigh, released a statement which said, in part:

“As soon as the facility became aware of the family’s allegations, an investigation was initiated. We understand the family’s concern and regret that this occurred. The staff involved were terminated for their inappropriate conduct. The remaining staff received additional in-service training.”

 

McKnight’s reported that a Pennsylvania jury has compensated the family of a dementia patient who was sexually assaulted by a fellow resident of her nursing home with a $7.5 million verdict.  After a two-week trial, a jury found Maple Farm Nursing Center and its parent company were 85% liable for the 2013 sexual assault.

The jury also found that the facility, owned by Garden Spot Village, had shown reckless indifference in failing to prevent the assault by a resident with a known history of sexual violence, according to The Legal Intelligencer. A plaintiff’s memo contended that accused resident, Glenn Hershey, targeted the 82-year-old victim, because of her dementia. Maple Farm knew Hershey was a registered sex offender who had previously been convicted of rape, and in its own filing said it had screened Hershey before admitting him.  Hershey had threatened to rape a caregiver and cited concerns the facility’s staff raised about “sexually aggressive behavior” toward the eventual victim prior to the assault.

Defendants attempted to prevent a nursing home employee from testifying based on the Older Adults Protective Services Act, However, the Act does not prevent individuals who report elder abuse from testifying in subsequent civil litigation. A three-judge panel rejected the nursing home’s argument that its employee’s testimony was privileged under the act.  The plaintiffs were allowed to depose the employee who reported the abuse to the Lancaster County Office of Aging.  Employees knew the two were in a relationship, although staff did not believe the victimized resident could consent because of her condition.

Instead of appealing the jury’s May 3 decision, Garden Spot Village agreed the next day to settle the case for $6.5 million “in conjunction with its insurer.”

 

Law360 had an interesting article about the Trump Administration decision to ignore requests for public information about nursing homes.  At least four lawsuits have been filed in federal courts since early April accusing CMS of wrongly impeding access to various records. The allegations include improper redactions and charging of excessive fees in violation of the Freedom of Information Act.

Abuse and neglect in the nation’s 16,000 nursing homes is a widely recognized problem. Two years ago, the U.S. Department of Justice launched 10 task forces targeting “grossly substandard care” in nursing homes. Last year, a federal watchdog urged CMS to take “immediate action” to address the underreporting of physical and sexual abuse in the nation’s nursing homes.

“The Trump administration is hindering plaintiffs attorneys who investigate abuse and neglect of seniors by heavily redacting nursing home records and charging tens of thousands of dollars to produce such records, according to interviews, government correspondence and newly filed lawsuits.”

This is clearly a decision to help the nursing home industry cover up neglect and avoid accountability.   Some of the recent litigation brought by plaintiffs attorneys is aimed at gathering evidence of the administration’s motivations. In a lawsuit filed last month, two plaintiffs attorneys — Ernest Tosh of Tosh Law Firm PLLC and David Marks of Marks Balette Giessel & Young PLLC — sought any communications between CMS and third parties concerning the disclosure of nursing home records.  The attorneys want those communications in order to determine “whether CMS’ reversal of its prior policy regarding disclosure … resulted from, or was influenced by, pressure from nursing home industry representatives or others acting at their behest,” according to the suit.

Another lawsuit that Tosh and Marks filed last month accuses CMS of excessively redacting nursing home records. According to the suit, the federal agency in July 2017 demanded $9,000 to produce records, and so Tosh requested a sample of the records to ensure that they would be worth the money.

“The redactions included in the sample provided to Tosh indicate that any records [CMS] does eventually produce will be unlawfully redacted and functionally useless,” the lawsuit says.

Steele’s lawsuit is aimed at forcing CMS to certify its own estimates of appropriate staffing levels in nursing homes. CMS employees usually cannot be subpoenaed to testify about the accuracy of those estimates, and so certifications are essential to using the estimates as evidence that nursing homes were understaffed when patients suffered harm.

“It’s literally the only way we can use this in court cases,” Steele said.  “I think there absolutely was some sort of directive that came down … to cut off the spigot of data,” Steele said. “Because this data’s getting used effectively to hold these nursing homes responsible for the way that they’re treating their residents.”

The cases are Johnson v. Centers for Medicare & Medicaid Services, case number 2:18-cv-00590, in the U.S. District Court for the Western District of Washington, The Steele Law Firm LLC v. U.S. Department of Health and Human Services et al., case number 4:18-cv-00275, in the U.S. District Court for the Western District of Missouri, and Tosh et al. v. U.S. Centers for Medicare & Medicaid Services et al., case numbers 1:18-cv-00915and 1:18-cv-00949, in the U.S. District Court for the District of Columbia.

 

Vox had an article about The Urban Institute’s plan to expand health insurance coverage: the Healthy America program.  The plan incorporates the existing system, especially the employer-based coverage that covers half of Americans, and offers a public option similar to Medicare and Medicaid to more people.

The article gives a great summary of the plan:

  • A new insurance market would feature private health plans and a public option.
  • Much of the Medicaid population would move into this new market: Children and the disabled would receive supplemental benefits to make sure they get the same level of coverage as they currently do, and the program would continue to cover long-term care separately.
  • The default plan would be more generous than the ACA’s: covering 80 percent of health care costs, compared to 70 percent. Lower-income people could also choose plans that cover an even higher share of their health care costs.
  • Premiums would be based on a sliding scale and more generous than Obamacare’s. People who make 138 percent of the federal poverty level or less ($27,000 for a family of three) would pay no premiums for that default plan, and premiums would rise slightly the more income a person makes. There would be no upper limit for subsidies as there is under the ACA: A family making more than 400 percent of the federal poverty level ($98,400), which is the current cut-off for assistance, would not have to pay more than 8.5 percent of their income on premiums for the default plan.
  • Rather than have an individual mandate, Americans would lose a share of their standard tax deduction if they were uninsured. The goal is to find a balance between the need to encourage healthier people to buy insurance while recognizing the unpopularity of the mandate, the Urban Institute researchers said.
  • Low-income people — those eligible for food stamps or cash welfare programs — would be automatically enrolled in an insurance plan if they are found to be uninsured.
  • Payments to health care providers under these Healthy America plans would be capped at Medicare rates.
  • Obamacare’s rules prohibiting preexisting conditions and requiring that certain essential health benefits be covered would remain.
  • Employer-based insurance, the traditional Medicare program, the Veterans Administration health care program, and the Indian Health Service would be left in place.

At the top level, there are several important features to this plan

  1. It would not disrupt the existing employer or Medicare populations. I think that is the first challenge for a universal single-payer plan, so the Urban plan seeks to avoid it — though the tradeoff is it will not achieve universal coverage.
  2. By combining the Medicaid population with the individual market, the Healthy America program would have a bigger customer base (and risk pool) than Obamacare currently does, which could help prevent some of the adverse selection that has driven up costs in the ACA. The caps on provider payments would also help keep costs down.
  3. Much of the program’s costs (another challenge for a truly universal health care system) would come from existing sources — Medicaid and the ACA in particular. But there would be a need for new funding: Urban suggests increasing an existing Medicare tax to raise about $800 billion over 10 years, which they think would cover much of the new costs.

The Urban Institute projected that if we swapped out Obamacare for Healthy America, the uninsured rate would drop from 10.9 percent to 6.7 percent in 2019. That would still leave 18.4 million Americans uninsured — a big flaw, I’m sure, in the eyes of people advocating for a truly universal health care program — but that is down from 34.3 million uninsured currently.

Slate had an interesting article arguing that ObamaCare was working until Trump’s sabotage of the health care plan.  New data shows that, in 2017, the market finally stabilized. For every dollar they collected in premiums last year, insurers paid out 82 cents on medical claims on average, according to a recent report by the Kaiser Family Foundation. That’s down from 96 cents in 2016 and $1.03 in 2015. “After several years, the remaining insurers figured out how to earn a profit in the individual insurance market,” Kaiser Senior Vice President Larry Levitt said.

Insurers adjusted their premiums high enough that insurers could finally make a profit, and would set the market up for much gentler, single-digit price increases in the future.  However, thanks to Donald Trump’s decision to stop paying key subsidies to insurers, premiums shot up once again this year. Early evidence suggests they’ll rise by double digits once again in 2019 in order for insurers to avoid losing money, largely because Republicans chose to repeal Obamacare’s individual mandate, which kept insurance prices down to some degree by requiring all adults to obtain coverage. Middle class families that don’t get financial help are going to take a hit, and many could be priced out of the market.

Again, this could have easily been avoided, had Republicans just left the law alone, instead of trying with every ounce of their power to wreck it. For a hot second, Obamacare was working roughly as intended. And now it’s broken again, and the uninsured rate and cost of health care is on the rise.

 

Shephard Spruill, the CEO of Carolina Support Services, has received a prison sentence in connection with a Medicaid fraud scheme in North and South Carolina.  A news release from the U.S. Department of Justice said Spruill was sentenced to eight years in prison followed by three years of supervised release.  According to prosecutors, he supplied hundreds of patient names to third parties who illegally billed millions in fictitious mental health services defrauding the U.S. taxpayers.

Prosecutors say Spruill has been ordered to pay nearly $6 million to the Medicaid programs in North and South Carolina, as well as to one of the individual victims. He also has to forfeit nearly $1 million in criminal proceeds and is banned from Medicaid for life.

“Do not for a moment believe that we have given a pass to those who steal from taxpayers through fraud,” Higdon said. “This case shows our continuing resolve to bring all to justice, even CEOs who commit their crimes with lies instead of guns.”