Monthly Archives: December 2019

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The growth of spending on nursing home services and continuing care retirement communities (CCRCs) increased by 1.4% to $168.5 billion according to the latest figures released by the Office of the Actuary at the Centers for Medicare & Medicaid Services.  That is ridiculous.  The quality of care should be much higher.

Overall, spending on nursing and CCRC services made up 5% of the total U.S. healthcare spending in 2018.

Healthcare spending increased 4.6% to reach $3.6 trillion in 2018.

Spending on hospital care reached $1.2 trillion and made up 33% of total healthcare spending in 2018.

Additionally, spending on home health care services reached $102.2 billion, an increase of 5.2%, Medicare and Medicaid made up 75% of home health spending in 2018, the report stated.

According to report published by Grand View Research, The U.S. skilled nursing facility market size was estimated at $176.1 billion in 2018.  The  U.S. skilled nursing facility market size is expected to reach $276.8 billion by 2026, according to the report by Grand View Research, Inc.

Grand View Research provides syndicated as well as customized research reports and consulting services on 46 industries across 25 major countries worldwide. This U.S.-based market research and consulting company is registered in California and headquartered in San Francisco. Comprising over 425 analysts and consultants, the company adds 1200+ market research reports to its extensive database each year. Supported by an interactive market intelligence platform, the team at Grand View Research guides Fortune 500 companies and prominent academic institutes in comprehending the global and regional business environment and carefully identifying future opportunities.

Growing aging population with increasing care needs and rising prevalence of chronic diseases in the country will propel the need for skilled nursing facilities (SNFs). In addition, lower costs of SNF as compared to hospitals will drive the market. SNFs cover numerous aspects such as therapy, mental health services, special dietary needs, hygiene items, recreational activities, and housekeeping.

Favorable reimbursement scenario is a crucial factor propelling market growth in the country. For instance, Medicare Part A covers skilled nursing care services in essential conditions for a reduced time period. Medicare-covered services include physical therapy, occupational therapy, medical social services, medications, dietary counselling, skilled nursing care, semi-private room, meals, and ambulance transportation.

Competition in the market is very high, with major participants being Brookdale Senior Living Solutions; Genesis HealthCare; and The Ensign Group, Inc. Typical barriers in the industry for new entrants include strict regulations and licensing hassles. Furthermore, rise in the costs of utilities, food, real estate taxes, and insurance could negatively affect the market.

Key Takeaways from the report:

  • By type of facility, freestanding held the maximum share in 2018 and is estimated to be the fastest growing segment in the U.S. skilled nursing facility(SNFs) market. This can be attributed to lower cost of care and increased Medicare payments
  • Based on ownership, for-profit facilities dominated the market due to increased acquisition and ensuring financial viability
  • Strategic initiatives undertaken by various market players are expected to help maintain its growth in the following years
  • Some of the key market players are Brookdale Senior Living Solutions; Genesis HealthCare; The Ensign Group, Inc.; EXTENDICARE; Sunrise Senior Living, LLC; Life Care Services; HCR ManorCare; Golden LivingCenters; Life Care Centers of America Corporate; and SavaSeniorCare Administrative Services LLC.


The AARP and 13 other organizations support legislation that would prohibit nursing homes from requiring residents to waive their constitutional right to a  jury trial by allowing mandatory arbitration agreements with residents prior to any abuse, neglect, or acts of malfeasance.

The organizations are leaders and experts in long term care, elder law, and consumer advocates including The Long-Term Care Community Coalition, Justice in Aging and National Consumer Voice for Quality Long-Term Care.

The use of pre-dispute arbitration agreements is fundamentally unfair, and facilities and home and community-based services (HCBS) providers that receive federal Medicaid and/or Medicare funding should not be permitted to impose them on consumers,” the groups said in a letter to legislators.

When a person is seeking care for themselves or a loved one, they should be able to focus on the quality and range of services available. No one should be expected to anticipate or contemplate the occurrence of grievous harm or poor care when these agreements are signed upon admission or when one is about to begin receiving services,” the groups added.

McKnight’s reported that a bankruptcy court has approved a reorganization plan for Dallas-based skilled nursing and senior living provider Senior Care Centers LLC which owns more than 100 SNFs and senior living communities in Texas and Louisiana. The U.S. Bankruptcy Court for the Northern District of Texas is allowing the company to be restructured into a new company owned by unsecured creditors, the Wall Street Journal reported.  The company stated the restructuring allows it to continue caring for patients and residents without interruption.

Senior Care Centers executives announced the bankruptcy filing last December after numerous fiscal challenges. The company described the move as the best way to “address the company’s debt and costly leases” and improve financial resources.


At least six states have adopted measures that allow for in-room cameras at nursing homes within the last several years. The videos prevent abuse, neglect, and prevent Medicaid/Medicare fraud and waste.  Ohio families may soon be allowed to install surveillance cameras in the rooms of nursing home residents under a new proposal.  Ohio State Rep. Juanita Brent issued a letter last week asking for co-sponsors on forthcoming legislation that would allow residents of a residential facility to conduct electronic monitoring in their rooms, News 5 Cleveland reported.

If approved by state lawmakers, residents or their power of attorney would have to first agree to any surveillance camera being installed in their room.

The goal behind this legislation is to give elderly residents and their families the option to place an ‘electronic monitoring device’ in a fixed position to record activities and sounds occurring in the room. The objective is to mitigate the occurrences of Elderly Abuse within nursing home settings in Ohio,” Brent wrote.



Sen. Lindsey Graham’s hypocrisy towards President Donald Trump is highlighted on a daily basis by a new Twitter account that pretends to be the South Carolina Republican’s conscience.  The account uses Lindsey’s own words against him.  Each day, the @LGsConscience feed shares one short clip of Graham blasting Trump before and in the immediate aftermath of the 2016 presidential election.

Barry Rubin, a senior video editor for conservative news website The Bulwark, launched the account and said in a press release that he has more than six hours of footage of Graham trash-talking Trump to draw from for the videos.

He plans to repeatedly call out Graham’s apparently forgotten claim that he’d “never be able to forgive Trump for saying mean things” about the late Sen. John McCain (R-Ariz.)

Lindsey Graham’s (fake) Conscience@LGsConscience
 MARK MY WORDS, @realDonaldTrump will lead to the destruction the @GOP

Embedded video

“The point is to show that associating yourself with Trump corrupts your soul,”


Christianity Today is a well known magazine founded by Billy Graham in 1956.  The conservative magazine published an editorial calling for Trump’s removal from office.  The move by the flagship evangelical magazine was unexpected because it normally avoids weighing in on politics.  The facts revealed in the House impeachment process are “unambiguous.”

“The president of the United States attempted to use his political power to coerce a foreign leader to harass and discredit one of the president’s political opponents,” wrote Galli. “That is not only a violation of the Constitution; more importantly, it is profoundly immoral.”

The editorial also issued a direct appeal to the magazine’s evangelical readers.

“To the many evangelicals who continue to support Mr. Trump in spite of his blackened moral record, we might say this: Remember who you are and whom you serve. Consider how your justification of Mr. Trump influences your witness to your Lord and Savior,” Galli wrote. “Consider what an unbelieving world will say if you continue to brush off Mr. Trump’s immoral words and behavior in the cause of political expediency.”

Trump attacked the publication and those that read it and said that “no president” before him has done more for the evangelical community and continued to criticize the publication claiming he has done more than any other president for “religion itself.”

The editorial came one day after the House of Representatives approved two articles of impeachment against Trump for abusing his office in his dealings with Ukraine and obstructing the congressional inquiry into those dealings.


President Donald Trump just admitted in the course of paying $2 million in court-ordered damages to resolve accusations that he and his family stole from charities. Wow.  Here are just some of the incredible admissions.

1. When he had the Trump 2020 campaign illegally place the Trump Foundation’s name on promotional materials and ceremonial checks related to a fundraiser that he, as a candidate, held for military veterans in January 2016. The Trump Foundation as a charity can’t participate in political campaigns.

2. When he used $100,000 of the Trump Foundation’s money—which was raised from other people—to settle a zoning dispute that his home was having with the city of Palm Beach, Florida.

3. When he used $157,820 of the Trump Foundation’s money to settle a legal dispute with a man who’d won a $1 million hole-in-one prize during an event held by another charity at a Trump golf course in New York.

4. When he used $25,000 of the charity’s money to make a donation to a political group that supported then–Florida attorney general Pam Bondi at the same time that Bondi was considering whether to sue “Trump University” for defrauding its “students.” Bondi did not but other attorneys general did, which led to another multimillion-dollar fraud settlement that Trump paid since taking office. Blondie Bondi now works for the White House as a special adviser to Trump on matters related to impeachment.  Do they understand irony?

5. When he used the Trump Foundation to pay $5,000 to put an advertisement for the Trump International Hotel in D.C. into a program distributed at another charity’s fundraising event.

6. When he used $10,000 of the Trump Foundation’s money to buy a painting of himself that he hung inside his Doral resort in Miami.

7. When he used $32,000 of the Trump Foundation’s money to pay “stewardship” costs for a piece of property in Westchester County, New York, that he’d donated to a land preservation group (but only after attempting unsuccessfully to build a golf course and luxury housing on it).

The Advocate had a great article on how, when, and why to choose hospice services for someone suffering from Alzheimer’s Disease.

Hospice care is a type and philosophy of care that centers on easing the pain and symptoms of a terminally or seriously ill patient and attending to that patient’s emotional and spiritual needs. Hospice care is provided by a team of professionals, which may include a medical director, the attending physician, nurses, social workers, counselors, clergy and home health aides. Once hospice care is ordered by the physician, and the patient is enrolled in that care, the team meets regularly to evaluate and coordinate a plan of care.

At end-stage Alzheimer’s disease, the goal of hospice is to keep that person as comfortable as possible.  One member of the team should be available 24 hours a day to address issues and concerns. Hospice care can be offered in a home, nursing home, assisted living facility or an in-house hospice care facility.

 Because the span of Alzheimer’s disease can run from seven to 20 years, it is often difficult to know when hospice care is warranted. Generally, a hospice referral is issued when someone with Alzheimer’s is severely impaired when walking and eating, becomes incontinent, experiences frequent choking episodes or has difficulty breathing, is unable to speak or communicate meaningfully, or has significant weight loss.

With the progression of the disease, other conditions are also associated in the late stages such as aspiration pneumonia, urinary tract infection, septicaemia and decubitus ulcers. Health conditions such as cardiovascular disease or congestive heart failure, lung disease, strokes, diabetes, renal failure and cancer also could significantly impair the affected patient’s health and functionality.

The decision for hospice is made when the goals of the patient and family members are palliative and not life-prolonging. The criteria for acceptance into hospice care include: diagnosis by a licensed physician as having end-stage Alzheimer’s, with limited life-expectancy (six months or less); residing within the specific geographic boundary of the hospice service; and consent by the family/caregiver of the affected person.

Medicare, Medicaid and many private insurance policies cover hospice care costs.

In choosing a hospice provider, you would want to consider the provider’s services and reputation, if the staff is specifically trained in Alzheimer’s disease and the plan of care developed by the staff. You can also ask if the hospice provider is licensed by the state or accredited by a licensing organization, such as the Joint Commission on the Accreditation of Healthcare Organizations.

Syracuse police arrested a certified nurse aide Nov. 25 after conducting a lengthy investigation into allegations that Cania Williams slapped a 90-year-old resident in the face with a wet cloth, injuring and bruising the elderly woman. The incident occurred on Oct. 19 at Bishop Rehabilitation & Nursing Center.

Williams was charged with endangering the welfare of an incompetent or physically disabled person in the second degree, a class A misdemeanor, and harassment in the second degree, a violation. The injuries were not severe enough to charge Williams with assault.

If convicted of the misdemeanor charge, Williams could be sentenced to up to a year in prison, three years of probation and a substantial fine.

Two other employees who may have known of the incident were suspended when Bishop began its investigation and have since returned to work, according to Newman.

In the wake of the incident Newman said the nursing home has re-educated employees on abuse reporting, identifying abuse, resident rights and handling residents with dementia.