The operator of South Star Ambulance Service alleges that Pruitthealth—Augusta Hills facility repeatedly tapped the ambulance company for inappropriate, non-emergency services over a two-year period, and is asking for more than $150,000 back for those trips. SSAS first filed suit against Pruitthealth—Augusta Hills on April 8 for repeatedly ignoring warnings to more judiciously use its services.

Regional Services, which operates the ambulance company, alleges that since the SNF is a Medicare-eligible provider, it should apply for reimbursement for non-emergency ambulance transport. The alleged inappropriate trips were made between August 2016 and September 2018, according to the lawsuit.

Parent company Pruitthealth is based in Norcross, GA, and operates about 180 facilities in Georgia, Florida, and North and South Carolina.

Voorhees Care and Rehabilitation Center lost its air conditioning on a hot summer day.  While temperatures rose throughout the day placing residents and caregivers, management refused to do anything about the dangerous and oppressive heat.  A worker said many of the lights in the building were off to try to keep the place cool. Nursing home facilities in New Jersey are required to establish a written heat emergency action plan which mandates the procedures to be followed if the indoor air temperature is 82 degrees or higher for a continuous period of four hours or longer, officials said.

Finally, a visitor was so concerned about the community, the police were called as the heat wave sent temperatures outside to triple digits.  Dozens of first responders began arriving to help evacuate more than 100 residents out of the facility.

Nursing home owners and operators declined to say why they did not alert anyone to the crisis, or what went wrong with their air conditioning system.

The nursing home is rated at the bottom for its quality of care, ranked “much below average,” according to the most recent report by the U.S. Centers for Medicare & Medicaid Services. That report in April 2018 concluded the facility had failed to maintain a clean and sanitary environment that was in good repair.  According to state health officials, the department was never notified by the facility about the deteriorating conditions, and was not involved in the evacuation.

Inside the facility’s lobby, though, it still felt muggy in the early afternoon. A portable air conditioning unit sat on the floor near the entrance, an exhaust tube snaking into the ceiling.

Reuters had an interesting article on a recent study found in JAMA Internal Medicine.  Numerous nursing home residents develop preventable health problems after they are returned from the hospital in stable condition, a new study shows.  More than half of the complications were related to poor residential care resulting in preventable conditions like pressure ulcers, skin tears and falls, the study found.  Another 28% of adverse events involved infections. A total of 38% of the complications were serious.  7.4% were life-threatening. 2.1% were fatal.  About 70% of the adverse events were preventable, researchers report in JAMA Internal Medicine.

“Adverse events are occurring due to transition related issues (such as being released from the hospital too soon as well as deconditioning requiring increased support from nursing home staff including monitoring to prevent falls, turning in bed to prevent/heal pressure ulcers, and gentler handling to prevent skin tears,” said

“Families should advocate for their loved ones and make sure they do not leave the hospital too early,” Dr. Alok Kapoor, lead author of the study and a researcher at the University of Massachusetts Medical School in Worcester said by email.

“It is important to realize that a nursing home patient who was recently hospitalized is at very high risk for problems over the next several weeks,” Bhatt said by email. “So don’t think they are out of the woods yet.”

In 1959, the Department of Housing and Urban Development (HUD) created a program that provides loans to start up new nursing homes and assisted living facilities across the US.  This program was meant to keep care for the elderly viable and affordable in rural or lower-income communities which would otherwise be unable to sustain such a facility. Since the program began, however, it’s become an easy way for some business owners to get loans backed on for-profit nursing homes that are practically doomed at the start.

Back in late 2013, Zvi Feiner and a group of investors bought the Rosewood Care Centers, a chain of 13 nursing homes and assisted living facilities in Illinois. The Department of Housing and Urban Development insured the loans for the centers’ creation, so they were automatically implicated when the Rosewood Care Centers went on a downward spiral. Feiner started losing money on the facilities soon after he bought them, with a team of investors, and began diverting Rosewood’s government-backed funds to other businesses. The HUD program eventually had to come to Rosewood’s rescue when their operation ran out of money and the agency had to take it over.

This HUD program is increasingly known for its lack of oversight and its loss of money on these nursing homes and assisted living facilities. Yes, owners like Feiner are at fault for moving those funds and allowing negligence in those facilities, but HUD backed those for-profit facilities and paid little attention to their nefarious activities before it was too late. Not only is the program poorly run and bad for the government financially, it’s also bad for the residents. Some studies are finding these facilities which take government backing, especially the for-profit ones, are more likely to receive bad quality ratings and ultimately endanger their residents.

The families of many Rosewood patients have filed lawsuits due to the facilities’ negligence. Other facilities backed by the HUD program face similar widespread issues. If the program continues the way it is, it might only further the danger surrounding the businesses it backs.

Back in 2015, the drug company Pfizer found a strong possibility that Enbrel, their rheumatoid arthritis medication, could significantly reduce the risk of Alzheimer’s disease. Based on an analysis of insurance claims, researchers from Pfizer found that Enbrel could potentially reduce Alzheimer’s risk by 64 percent.

Researchers in the company wanted to do more research relating to Enbrel’s connection with Alzheimer’s. Pfizer decided against it because it would not be as profitable.  Around the same time Pfizer made its decision not to support Alzheimer’s research with Enbrel, they also decided to shut down their neurology department where the testing would have occurred and lay off 300 employees.  Pfizer also had the option to publish its data for other researchers to use, but decided not to share the important research.

Some outside researchers and scientists think Alzheimer’s might be very closely related to inflammation and the correlation between Enbrel and Alzheimer’s prevention might not be coincidental.

 

The Wisconsin State Journal recently reported a tragic tale of greed and avarice.  An assisted living facility evicted a resident last month because she went on Medicaid, even though the facility said it would keep her once she was in the program if she first paid out of pocket for six months, which she did.  Pols went on Family Care, a state Medicaid program, in early June, after depleting her savings by paying nearly $30,000 to Heritage from December to June, Redmond said.

Jenny Pols’ involuntary discharge from Heritage Senior Living appears to be a wrongful eviction stemming from low Medicaid reimbursement rates. Facilities verbally pledge to keep residents after they go on Medicaid, but rarely put those promises in writing.

Pols, who received an involuntary discharge notice from Heritage June 25, moved last week to Willow Pointe, an assisted living facility in Verona.  Margo Redmond, Pols’ caretaker, said Heritage told Pols and Redmond in November that Pols could stay even after going on Medicaid if she first paid privately for six months. Redmond called the facility’s actions “fraudulent inducement.” Heritage on June 25 refunded about $6,000, apparently for Pols’ advance payment for June, Redmond said.

“I should have walked, but I had already heard from many people in the aging field that these facilities never put anything like that in writing,” she said. Pols, born in the Netherlands, worked in the United States as a nurses’ aide at a nursing home run by Redmond’s mother and became a family friend.

 The June 25 notice to Pols from Bobbi Stoltz, executive director of Heritage, said: “We are not required by law to continue residency for any individual once they convert to the Family Care Program and the lower monthly reimbursement rate. Therefore, we are issuing this 30-day Notice of Discharge.”

Heritage’s executive director at the time said Pols could stay once on Medicaid if she first paid privately for six months, Redmond said. When Redmond asked him to put that in writing, he said he couldn’t but shook hands in agreement, she said.

Amanda Runnoe, Heritage’s vice president of clinical and quality operations, told the Wisconsin State Journal in a statement that “there was discussion as to our commitment and efforts to retain current residents if and when they must transition to Medicaid reimbursement … but it was made very clear that we do not and can never make such a guarantee or promise.”

Most assisted living facilities in Wisconsin accept some residents on Medicaid, but facilities sometimes limit the number of such residents to remain financially viable, said John Sauer, president and CEO of LeadingAge Wisconsin, which represents assisted living facilities and nursing homes. Heritage is not a member of the association.
With assisted living becoming more widely used, consumers need to fight for their rights, Redmond said. “If enough of us say we’re walking unless we have something in writing, this will stop,” she said.

More maternal deaths and injuries occur in the U.S. than any other developed nation.  The vast majority are preventable. In this country, already the most dangerous in the developed world in which to have a baby, South Carolina has one of the worst track records when it comes to women’s health during childbirth. The state ranks in the top ten in the most maternal deaths and the most maternal harms.

The hospitals and doctors often blame the victim’s age, weight, and socioeconomic status of the woman giving birth. But as more research comes out regarding these incidents, including about two deaths every day, it seems negligence on the part of the healthcare provider could have much more to do with these incidents than a woman’s personal history.

The two leading causes of life-threatening incident when it comes to childbirth are blood pressure and blood loss. When a mother’s blood pressure becomes too high before, during, or after delivery, there’s a chance of serious complications like a stroke. When she begins losing too much blood her internal organs could shut down or cause a number of other life-threatening issues. Neither of these issues are particularly difficult to detect, nor do they necessarily correlate to a fault of the mother’s, but hospitals across the country are still failing to make sure their patients have what they need to prevent life-threatening cases. They could be weighing bloody pad to measure their patients’ blood loss, measuring their blood pressure and prescribing medication for it when it gets too high, and taking a number of small steps to prevent disaster. But they aren’t.

Part of the reason it’s so hard to make large-scale changes to the way childbirth is handled in America is that the medical community has to come to a consensus that their current methods aren’t enough and they need to implement new techniques to save these mothers. Doctors and nurses who’ve been working for years, who have experience watching these kinds of stories unfold, don’t necessarily want to change the way they treat patients, or they sometimes don’t even know of these new medical advancements.

In other developed countries, it’s often easier to get new standards of care implemented because they have a universal healthcare program. When all hospitals are publicly funded they have to abide by all the new, agreed upon techniques the government wishes to implement.

In the U.S., doctors and nurses are freer to treat how they please. That freedom, however, might come at the price of negligence and treatment methods that harm new mothers across the country.

Federal prosecutors disclosed that Dr. Ronald Hargrave of Mount Pleasant, S.C. has been convicted of trading painkillers and anti-anxiety drugs for money and sex.  The jury found Dr. Hargrave guilty of distribution of controlled substances after a four-day trial.

Investigators said they started looking into Hargrove in 2105 after he went with a woman to a Columbia pharmacy around midnight on a Saturday with a Xanax prescription.

Prosecutors said in a statement the pharmacist refused to fill the prescription because it was odd to have a doctor accompany a patient to the drug store, especially out of town.

Authorities six Hargrove exchanged sex in his office for painkillers in another case in 2017.

Hargrove faces up to 20 years in prison when he is sentenced later.

McKnight’s reported on the forseeable suicide of an assisted living resident in a Five Star Senior Living community in Arkansas.  Staff members at Morningside of Springdale assisted living community cut back on the number of checks they conducted on his room which allowed the man time to commit suicide.  The man had a history of considering suicide and had objected to the every-two-hours room checks required by the state, according to an investigation by the state’s Office of Long Term Care.

Staff members agreed to accommodate the resident’s request for less frequent checks. He died April 23 in his room, and Morningside reported the death to the state and local authorities, officials said.

The New York Times recently reported on the Trump Administration’s continued attempts to remove protections for people with pre-existing medical conditions and other protections in the Affordable Care Act.  A case filed by Republican politicians is on appeal and may make its way to the Supreme Court ahead of the 2020 election.  The Trump administration refused to defend the full law in court and agreed with the ruling that the law’s requirement for people to buy insurance was unconstitutional, and that as a result, the entire law must be dismantled.

The Affordable Care Act’s mandate requiring most Americans to buy health insurance or pay a tax penalty remained constitutional after Congress eliminated the penalty as part of the tax overhaul that Mr. Trump signed in 2017. When the Supreme Court upheld the mandate in its landmark 2012 ruling that saved the law, it was based on Congress’s power to impose taxes.

If the mandate is indeed unconstitutional, the next question is whether the rest of the Affordable Care Act can function without it.

If the current decision stands, the number of uninsured people in America would increase by almost 20 million, or 65 percent, according to the Urban Institute, a research organization. That includes millions who gained coverage through the law’s expansion of Medicaid, and millions more who receive subsidized private insurance through the law’s online marketplaces.

Insurers would no longer have to cover young adults up to age 26 under their parents’ plans; annual and lifetime limits on coverage would again be permitted; and there would be no cap on out-of-pocket medical costs people have to pay.

Also gone would be the law’s popular protections for people with pre-existing conditions. Without those protections, insurers could return to denying coverage to such people or to charging them more. They could also return to charging people more based on their age, gender or profession.

The Kaiser Family Foundation, a nonpartisan research organization, has estimated that 52 million adults from 18 to 64, or 27 percent of that population, would be rejected for individual market coverage under the practices that were in effect in most states before the Affordable Care Act.