Civil libertarians and constitutional experts fear that the president will use a moment of crisis to grab more power. Already, Trump has exploited the pandemic as a reason for heightening border restrictions and restricting asylum claims.

The Justice Department has secretly demanded Congress give Trump the ability to ask chief judges to detain people indefinitely without trial — part of a push for new powers that comes as the novel coronavirus spreads throughout the United States. The request raised eyebrows because of its potential implications for habeas corpus — the constitutional right to appear before a judge after arrest and seek release. A Justice Department spokesperson declined to comment.

The department also asked Congress to pause the statute of limitations for criminal investigations and civil proceedings during national emergencies, “and for one year following the end of the national emergency,” according to the draft legislative text.

Alex Spanko at Skilled Nursing News had a great article about private equity firms ownership of nursing homes.  Nursing home experts and consumer advocates have repeatedly expressed concerns about the rise of private equity investment in skilled nursing facilities, citing a lack of transparency and concerns over quality affected by short-staffing.  Putting profits over people. Recently released research appears to back up their arguments.  Then the coronavirus crisis hit.

A study from researchers at the University of Pennsylvania’s Wharton School, NYU-Stern, and the University of Chicago found that a variety of metrics — from the number of staff hours to overall five-star quality ratings — decline in the immediate wake of a private equity takeover. The Wharton-NYU-UChicago study did reveal negative trends associated with the years immediately following a building’s purchase by a private equity firm.

Following buyouts, we observe higher patient volume on the extensive and intensive margins, leading to an increase in bed utilization,” the team concluded. “We also find a robust decline in nursing staff, leading to greater decline in per-patient nursing staff availability. “

Private equity firms own about 11% of nursing facilities nationwide, according to the study. Investment in the space has accelerated in recent years, with MarketWatch noting that PE firms have poured $5.3 billion into nursing home deals since 2015 — compared to $1 billion between 2010 and 2014.

For example, the researchers tracked declines in overall star ratings and use of direct caregivers such as licensed practical nurses (LPNs) and certified nurse assistants (CNAs) in the wake of a PE takeover.  The researchers noted that the buildings tended to see declines in the staffing domains of their five-star ratings.

Even before the coronavirus crisis, members of Congress had issued loud public warnings to PE owners of nursing homes.

Back in November, a group of Democratic lawmakers that included former presidential candidate Sen. Elizabeth Warren of Massachusetts wrote a letter to private equity firms with holdings in the industry — The Carlyle Group, Formation Capital, Fillmore Capital Partners, and Warburg Pincus LLC — asking for more clarity around their operations.

“We are particularly concerned about your firm’s investment in large for-profit nursing home chains, which research has shown often provide worse care than not-for-profit facilities,” the lawmakers wrote in their letters. “In light of these concerns, we request information about your firm, the portfolio companies in which it has invested, and the performance of those investments.”

Nursing homes across the country have been instructed to ban all outside visitors to combat the spread of the new coronavirus among a vulnerable patient population, but consumer advocates and industry experts say the virus has put a spotlight on the underpaid and overworked staffers who care for vulnerable adults. Based on known infection control procedures, nursing homes were well aware of the dangers of the virus and failed to take the appropriate steps to prevent patient injuries. The root cause of the many problems of nursing homes is that you have too few workers with too little time.

Appropriate steps include proper training and adequate number of staff to anticipate and meet the needs of the residents.  But many elder care facilities are understaffed, with low-paid certified nursing assistants, or CNAs, carrying most of the load of patient care. CNAs are often asked to perform patient care duties beyond the scope of their expertise.

Mahoning Matters reported the sad and tragic death of Thomas Ward Sr. He was a resident of the Oasis Center for Rehabilitation and Healing nursing home for less than two months in 2018, but during that time developed an infestation of maggots between his nasal passages and throat, along with severe bed sores and other health complications that led to his death, according to a new lawsuit.

Ward was admitted to the facility to receive nursing care and rehabilitation following a stroke, according to the complaint. The neglect Ward suffered caused the development of an infected Stage 4 pressure injury.  Stage 4 is the most severe level indicating the wound is past muscle and exposing bone with visible signs of infection. Ward also suffered an infestation of maggots in his oral cavity and oropharynx, along with a urinary tract infection and “other health problems and infections that ultimately led to sepsis and septic shock.”

Ward was discharged the following October to two different hospitals before he began receiving palliative care from a hospice provider, according to the suit. He died about two weeks later, on Oct. 13, 2018.

Oasis, which currently has an overall “below average” rating of two stars on Medicare.gov, has been a candidate for the state’s Special Focus Facilities list for six months, according to the most recent list released last month by the Centers for Medicare and Medicaid Services. The designation identifies nursing homes with the most health and safety citations, or which indicate a pattern of noncompliance with particular state standards.

According to the Medicare.gov Nursing Home Compare website, Oasis has been cited by state inspectors for 58 health and safety deficiencies since December 2016 and fined more than $114,000, the most of any nursing home in Mahoning and Trumbull counties during those three years.

 More than 60,000 people die each year due to pressure injuries or bed sores, according to a journal entry found in the U.S. National Library of Medicine, which was last updated in September.

Unfortunately, despite awareness of the problem, the rates of pressure wounds remain high in long-term care facilities and nursing homes, where a lack of staff and optimal care is not always possible,” the entry states.

Nursing homes were designed for high-needs residents and are heavily regulated by the federal government. Assisted living and other state-regulated homes were designed for healthier residents and are lightly regulated.  Vermont Public Radio and Seven Days investigated the lack of regulations for state-licensed facilities providing a home for vulnerable adults who may not need skilled care. In Vermont and elsewhere, investigations into these homes have revealed lax oversight, injuries and deaths.

A review of nearly six years of inspection reports revealed troubling patterns of inadequate care. At least five residents have died in accidents related to deficient care, and the majority of homes have been cited for severe infractions. One home’s owner told regulators that it was easier to accept a citation than to give staff the dozen hours of required annual training.

Homes that provide poor care are rarely fined by state regulators, who are acutely aware of their state’s need for long-term care beds. Vermont has one of the oldest populations in the nation, and people with dementia, such as Marilyn Kelly, can wait months for placement at a facility.

Vermont is not the only place where journalists have uncovered inadequate care and oversight at state-licensed long-term care facilities. The Atlanta Journal-ConstitutionThe Oregonian and PBS and ProPublica have published similar findings, with databases designed to help consumers.

“It could have been any state,” said Lori Smetanka after learning about VPR and Seven Day‘s findings in Vermont. Smetanka is executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group.

Be on the lookout for unfriendly staff interactions, unpleasant smells and sounds of distress. Confirm the staffing numbers. And do research. Ask your state’s long-term care ombudsman about what kinds of complaints have come in about the facility; read the contract carefully; and get a hold of the facility’s state inspection reports.

The Trump Administration will no longer allow federal investigators to oversee and supervise nursing homes. Federal regulators plan to halt inspections of nursing homes to focus on coronavirus cases in facilities across the nation. Unsafe practices, poor training, and inadequate staffing led to serious infractions at the hardest-hit location. Many nursing homes have long struggled with infection control, according to federal inspection records and researchers. They need oversight and inspections to maintain compliance with safe practices.

Under the changes, regular inspections of nursing homes, home health and hospice companies, will be paused for April. The number of abused and neglected residents will skyrocket in the next 30 days.  Especially since family and other visitors are prohibited from checking in with their loved ones.  The lack of oversight and inspection was made under the Trump administration’s declaration of a national emergency.

The move follows a recent inspection of the Life Care Center of Kirkland, a nursing home near Seattle, which is tied so far to 35 coronavirus deaths. CMS said the inspection found three major violations at the facility that put residents in imminent danger, including not quickly identifying and managing sick residents. Life Care said it had faced an unprecedented crisis and has fixed the issues.

 “Right now, the biggest threat to our nursing home residents is the coronavirus,” CMS Administrator Seema Verma said in an interview. “We cannot have a repeat situation like we had in Kirkland.”  However, she agency isn’t blocking one practice that the CDC said may have made several nursing homes in the Seattle area more vulnerable to the spreading outbreak: staff members who work at more than one nursing home.
Nursing homes house the population most vulnerable to the respiratory sickness: older, often frail residents with underlying medical conditions.  At least 146 nursing homes in 27 states have at least one infected resident, CMS said, citing data from the Centers for Disease Control and Prevention.

 

 

 

We see it all the time where a nursing home’s doctor has a bias against one of our clients because of race, gender, or sexual orientation. It clearly affects their ability to testify honestly and consistently with accepted medical practice.  A recent article from the New York Times explored bias in missed medical diagnosis.  Bias, which takes many forms, affects how doctors think and the treatment decisions they make.

Racial biases in treatment decisions by physicians are well documented. One study found that black patients were significantly less likely than white patients to receive pain medication in the emergency department, despite reporting similar levels of pain. Other research suggests that racial biases among providers contributed to racial differences in patient trust in the health system.

A growing body of scientific research on physician decision-making shows that doctors exhibit other biases as well — cognitive ones — that influence the way they think and treat patients. These biases lead doctors to make the same mistakes as the rest of us, but usually at a greater cost.  Cognitive biases refer to a range of systematic errors in human decision-making stemming from the tendency to use mental shortcuts.

Prominent examples include confirmation bias, the tendency to interpret new information in a way favorable to one’s preconceptions; and anchoring, the tendency to overly weight an initial piece of information, even when order does not matter.  In health care, such biases can  affect whether similar patients live or die.  A recent study analyzed gender bias in surgeon referrals and found that when the patient of a female surgeon dies, the physician who made the referral to that surgeon sends fewer patients to all female surgeons in the future. The study found no such decline in referrals for male surgeons after a patient death.

In a new study of physician treatment decisions published in The New England Journal of Medicine, signs of left-digit bias are investigated. Left-digit bias could affect many clinical decisions. For example, patients with hemoglobin levels of 9.9 grams per deciliter may be perceived as being substantially more anemic than patients with hemoglobin levels of 10.0 grams per deciliter (the difference in the two values has no clinical significance).The study confirms previous work that found doctors are overly responsive to patient age when diagnosing illness, and that showed how seemingly irrelevant factors‚ such as the difference of a few weeks of age, could govern physicians’ decisions about treatment, with potentially life-altering consequences for patients.

Based on the latest figures from the World Health Organization, the nursing home industry will see an increase in positive cases of Covid-19.  There are now more than 54,100 cases in the country, along with 644 deaths, according to the Centers for Disease Control and Prevention. The CDC also reported 160 nursing homes across the country have at least one resident with COVID-19.

The organization is seeing a “very large acceleration” in cases in the United States. Over a 24-hour time period earlier this week, WHO reported that 85% of new cases have been in the United States and Europe — with 40% of those being from the U.S. alone.

WHO spokeswoman Margaret Harris said the latest figures show that the U.S. “does have that potential” to become the new epicenter of the disease.

“We cannot say that is the case yet but it does have that potential,” Harris told reporters Tuesday. “They [the United States] have a very large outbreak and an outbreak that is increasing in intensity.”

It took 67 days from the first reported case to reach the first 100,000 cases, 11 days for the second 100,000, and just four days for the third 100,000,” WHO Director-General Tedros Adhanom Ghebreyesus said Monday.

Dr. Glenn Mollette is the author of Nursing Home Nightmares — America’s Disgrace. He wrote the column below and it was published in The Logan Daily News.

About 1.5 million American seniors now live in nursing homes. Seventy percent (70 percent) of them rely on Medicaid to pay the bill, which means they are low-income or have otherwise spent down their assets.

My mother spent the last few months of her life in a nursing home. My first wife died in a nursing home. My wife’s mother spent a lot of time in nursing homes. Today, I have elderly friends in nursing homes who I try to occasionally go and see. It’s the same old story. I continue to see a multitude of lonely, forgotten people who have been warehoused in facilities until they breathe their last breath.

Placing my wife in a nursing home was one of the hardest things I’ve ever done. She was in the final stages of multiple sclerosis and needed 24 hour care which I couldn’t physically give. However, looking back emotionally and even physically I don’t think I would have been as drained if I had just kept her at home and tried to have cared for her.

One worker told me once she was in charge of taking care of sixty (60) persons every night. She said that oftentimes there would be people she never saw on her shift.

Nursing home care cost is astronomical. Just a bed, three meals a day and an occasional bath will cost you around $7,500 a month. My mother-in-law needed rehabilitation. Three years ago her cost was over $15,000 a month for four months. My father-in-law shelled out $60,000 of their life savings for rehab. They had worked hard to save that money, but you can’t take it with you. However, most people don’t intend to work all of their lives so that they can turn their savings over to a nursing home.

Nursing homes are not a relief emotionally or physically and financially they will break you. Most Americans end up paying for their nursing home care via Medicaid. Going on Medicaid is no picnic as it means, in reality, you no longer have any means to pay for your care.

Twenty years ago I was the pastor of a church with a small salary and financially we didn’t have anything except a house payment. Going to the local county office for health and family services and applying for Medicaid for nursing home care for the care of my invalid dying wife was tough. It was our last resort. We were glad it was available but it was emotionally tough. It’s the same office where you go and apply for food stamps.

There are some good nursing homes out there and many, many hardworking, caring nurses. There are some really bad ones out there too and they are all extremely expensive.

All the time we hear about Americans being medically insured. What about long term care insurance for aging Americans? Our nation is getting older. The baby boomers are a large chunk of our population — 75 million! Baby boomers are going to face bankruptcies and mega financial challenges as is this nation with the long term care of our generation.

Our politicians must come up with a long term care plan that does not require the financial ruin of millions of Americans. I know long term care insurance is available if you are not sick and can afford it. However, somehow we have to add long term care insurance to Medicare. Yes, it will cost us every month to pay for it just like we are paying for part B now.

However, it would be for real medical care in the nursing home with real rehabilitation if it is needed; and not just for a bed and three meals a day and an occasional bath. Plus it would spare the elders in this nation from having to file bankruptcy and go into poverty to have a shelter over their heads the last few months or even years of their lives.

Please add this issue to the national discussion.