In Oklahoma, voters passed a measure expanding Medicaid to nearly 200,000 low-income adults after the state’s Republican governor declined to do so. That makes Oklahoma the fifth state to overrule its Republican executive and embrace a key element of the Affordable Care Act.  Most Republicans in Congress now represent states that have accepted the Medicaid expansion.

June saw more than 800,000 new coronavirus cases, bringing the total number of cases in the United States to more than 2.6 million.  The administration’s failure to “adequately prepare for the COVID-19 pandemic” and its “delayed and disorganized response” contributed to the pandemic’s deadly impact in nursing homes, according to a Senate report.  The running tally shows that nationwide more than 60,000 residents and staff have died from coronavirus outbreaks at nursing homes and other long-term care facilities as well.

The senators also accused the administration of not providing timely, complete and accessible COVID-19 case and death data for nursing homes. And the administration did not implement a national testing strategy and was too late in providing guidance on how to conduct new infection control oversight measures at facilities, the report said.

They issued a series of recommendations, which include providing PPE and testing to nursing home workers, ensuring adequate data collection, and giving workers sufficient pay and benefits. The lawmakers also called on the Centers for Medicare & Medicaid Services and Federal Emergency Management Agency to improve emergency management and infection control practices in nursing homes.

Urgent action is needed to address the tragedy that continues to unfold in nursing homes,” authors said.

Despite the pandemic spreading, the Trump administration is still trying to undo ObamaCare. Trump submitted a legal argument last week demanding the Supreme Court to throw out the law.  And Fourth of July gatherings have the potential to make a bad situation worse.

More than any other institution in America, nursing homes have come to symbolize the deadly destruction of the coronavirus crisis. More than 55,000 residents and employees of nursing homes and long-term care facilities have died, representing more than 40 percent of the total death toll in the United States.  They are taking on coronavirus-stricken patients to bolster their bottom lines.

The New York Times recently reported on the nursing home industry kicking out old and disabled residents including veterans, and sending them to homeless shelters, assisted living facilities, and rundown motels according to 22 watchdogs in 16 states, as well as dozens of elder-care lawyers, social workers and former nursing home executives. The New York Times contacted more than 80 state-funded nursing-home ombudsmen in 46 states for a tally of involuntary discharges during the pandemic at facilities they monitor. Twenty six ombudsmen, from 18 states, provided figures to The Times: a total of more than 6,400 discharges, many to homeless shelters.

The corporate bean counters have figured out how they can profit from COVID-19.  Nursing home employees even informed journalists that staff are being told to clear out less-profitable residents to make room for a new class of customers who would generate more revenue: patients with Covid-19.  Covid-19 patients can bring in at least $600 more a day in Medicare dollars than people with relatively mild health issues, according to nursing home executives and state officials.

Most of the evictions, known as involuntary discharges, violate federal rules that require nursing homes to place residents in safe locations and to provide them with at least 30 days’ notice before forcing them to leave. Fifteen state-funded ombudsmen said in interviews that some homes appear to be taking advantage of that void to evict vulnerable residents.

Nursing homes have long had a financial incentive to evict Medicaid patients in favor of those who pay through private insurance or Medicare, which reimburses nursing homes at a much higher rate than Medicaid. More than 10,000 residents and their families complained to watchdogs about being discharged in 2018, the most recent year for which data are available.

Nursing homes are allowed to evict residents only if they aren’t able to pay for their care, are endangering others in the facility or have sufficiently recovered. Under federal law, before discharging patients, nursing homes are required to give formal notice to the resident and to the ombudsman’s office. They must also find a safe alternative location for the resident to go, whether that is an assisted living facility, an apartment or, in rare circumstances, a homeless shelter.

Kaiser Health News had an article about Summit Hills, an assisted living facility in my hometown of Spartanburg, S.C.  The article explains the difficulty of preventing and containing the coronavirus when some people believe it is a hoax.  Since the start of the pandemic, the public has been barraged by conflicting messages in part because some politicians and scientists deliver conflicting advice. That is particularly true in the United States, where the coronavirus has somehow morphed into a right-wing political issue — and Americans increasingly reject information that doesn’t match their leanings.  Rumors, misinformation and outright falsehoods — some intentionally propagated — have flourished in the vacuum of leadership.

The article uses Administrator Regina Fargis who operates Summit Hills.  She took obvious precautions: no visitors, hand sanitizer everywhere and regular reminders for residents about the importance of social distancing. Summit Hills remained COVID-free until mid-June. Three residents and four employees have now tested positive and are being quarantined.

By mid-May, two residents had become convinced that the COVID-19 death count — which has surpassed 130,000 people in the U.S. — was a hoax manufactured by the media and Democrats. Some people may be dying, they said, but it wasn’t actually that severe. They didn’t think her precautions were necessary.

I don’t know how to respond, to tell you the truth,” Fargis said. “If someone has that kind of mindset, what kind of conversation do you have” to convince them of the pandemic’s severity and the need for strict precautions?

The misinformation includes the “Plandemic” video, Facebook posts claiming 5G cell networks cause the virus and articles suggesting it can be cured with garlic or using a combination of hot water with baking soda and lemon.

Research shows people who support Trump and rely on Fox News are more likely to believe the virus has been exaggerated. Republicans are more likely than Democrats to think that COVID-19 was never a threat and that the worst is over. That contributed to the push for early reopening in some states that had not met the requirements recommended by the Centers for Disease Control and Prevention for doing so. And Republicans are less likely than Democrats to don protective masks, which are believed to reduce the spread of the virus. (President Donald Trump famously has refused to wear a mask in public.) Now daily case counts are spiking.

In fact, political figures like Trump have held outsize influence in shaping public understanding. “The news feed abhors a vacuum,” said Jeff Hancock, a professor of communication at Stanford University who has studied the implications of COVID misinformation.  Misinformation spread by political figures and celebrities made up only 20% of the sample but accounted for 69% of engagement.

At Summit Hills, the politicization of COVID-19 has “without a doubt” made it harder for Fargis, its executive director, to convince her residents — many of whom would typically look to the federal government for credible information — of the pandemic’s severity.

When South Carolina began opening up, Fargis decided to see if the numbers of new COVID-19 cases declined significantly before lifting precautions. Now, with the virus in her facility, she has no intention of letting up social distancing rules and other prevention strategies.

And since May, at least one of her residents has since come around to understanding the pandemic’s severity. But another, she said, still emails her arguing that the virus has been overblown or that social distancing does not work and suggesting that unproven medicines — like hydroxychloroquine or beta-glucans — can treat or prevent the illness.

We’d all be far better off if we kept those nonsensical remarks out of the news,” she said. “The more misinformation we have, the more likely we are going to have lives at stake.”

With the White House narrative at odds with facts and data, health experts including Dr. Deborah Birx and Dr. Anthony Fauci have been silenced. Dr. Jonathan Reiner, a professor of medicine at George Washington University, told CNN it’s because “they tell the truth. And the truth is that the pandemic is still very, very active in the United States and that we’re not getting back to normal and there are difficult things that the public has to do,” Reiner said.
Fauci recently warned in an episode of the US Department of Health and Human Services’ podcast “Learning Curve” about an “anti-science bias” contributing to case spikes in the country.
One of the problems we face in the United States is that unfortunately, there is a combination of an anti-science bias that people are — for reasons that sometimes are, you know, inconceivable and not understandable — they just don’t believe science and they don’t believe authority.”  I wonder who he is talking about?
“So when they see someone up in the White House, which has an air of authority to it, who’s talking about science, that there are some people who just don’t believe that — and that’s unfortunate because, you know, science is truth.”
“We’ve never finished the first wave,” Hotez, dean of the National School of Tropical Medicine, said of spikes in new cases in South Carolina, Florida, Texas and Arizona. “We didn’t complete that social distancing period that we needed to do.”
Models showed states needed to extend stay-at-home orders through May, according to Hotez.
“Things opened up prematurely,” he said.

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While Trump seeks to tighten access to food stamps, Trump’s economic rescue package quietly allocated $135 billion for wealthy real estate developers. Officially, the provision is called “Modification of Limitation on Losses for Taxpayers Other Than Corporations”.

Jesse Drucker also wrote an article explaining that Trump himself, along with his son-in-law, Jared Kushner, will benefit financially from this provision. The fine print was mysteriously slipped into the March economic relief package at the last minute, even though it has nothing to do with the coronavirus and offers retroactive tax breaks for periods long before Covid-19 arrived. A new study determined that in the two months since March 18, roughly the start of the economic crisis, America’s billionaires saw their wealth collectively grow by 15 percent. And another 16 Americans became billionaires in that period.

About 82 percent of the Zillionaire Giveaway goes to those earning more than $1 million a year, according to Congress’s Joint Committee on Taxation. Of those beneficiaries earning more than $1 million annually, the average benefit is $1.6 million.  WOW.

In other words, a single mom juggling two jobs gets a maximum $1,200 stimulus check — and then pays taxes so that a real estate mogul can receive $1.6 million. This is dog-eat-dog capitalism for struggling workers, and socialism for the rich.

During the Great Depression, President Franklin Roosevelt responded boldly to economic desperation by creating jobs, passing Social Security and starting rural electrification. In this crisis, Trump is trying to restrict food stamps and health insurance while giving free money to real estate tycoons — probably including himself.

teaches bioethics and moral theology at Fordham University.  He wrote an op-ed for the New York Times. Below are excerpts.

We knew it from the beginning. A nursing home in Washington State was the center of the first known coronavirus outbreak in the United States. We knew that institutions caring for the elderly and disabled in close quarters would be particularly vulnerable during the pandemic.

But we did not act. Personal protective equipment, special training and extra staff went almost exclusively to our critical care facilities. Nursing homes got virtually nothing. Well, that’s not entirely true. In New York and other places we gave them patients, and even nurses, infected with the virus.

The result has been a raging wildfire of infection and death. We don’t have full reporting of anywhere close to all the deaths at this point, but the best estimates right now are that about half of those who have died from Covid-19 have been nursing home residents. In some places, it’s much more: Connecticut reported that nearly 90 percent of its Covid-related deaths between April 22 and April 29 occurred in nursing homes.

We tend to see this as a public health failure, but it is also a moral failure. That fact hit me recently, after I went on Fox News’s “Tucker Carlson Tonight” to talk about the plight of nursing homes.

Even before the pandemic, these were places where what I call “throwaway culture” was thriving. The staff aren’t paid a living wage, often have poor training and are hopelessly overworked. The residents face elder abuse, and large percentages of them are desperately lonely. A good number get no visitors at all, which pushes rates of dementia among residents to unbelievable levels.

I suggested to Mr. Carlson’s audience that it was no surprise that throwaway culture kicked into hyperdrive in nursing homes during our current moment. I was excited to be able to make my case to a national audience; afterward, I was exhausted. All I wanted to do was help my wife get our 2-year-old to bed and go to sleep myself.

But that’s when the messages started coming in. Email. Facebook messenger. LinkedIn. Twitter. One after the other after the other. And they were horrifying.
It is one thing for a professor of bioethics to cite abstract numbers and trends and offer a theoretical explanation for them. It is another thing to get message after message detailing the human toll of what you had just discussed.

One of the most moving — and frightening — was from a nursing home staffer. She said she was given inadequate P.P.E. and training, and had likely been exposed to the virus. Her communications with management were ignored. Staff members at her facility were not being tested. She decided to quit her job rather than risk infecting her residents. “I don’t know if you can help me,” she said. “I feel that what you said is true; the elderly need a voice by someone that cares.”

Another correspondent, who had worked in health care administration, said that she was “not surprised in the least that the hospitals were trying to discharge their Covid-19 infected patients” back to long-term-care facilities because, in her experience, this has “been happening for quite some time.” It got worse: Agreeing with me about the radical understaffing of nursing homes, she said that it is “increasingly common is to discharge high cost and difficult patients to homeless shelters … Yep, you heard me right … HOMELESS SHELTERS.”

Not every story was coronavirus-specific. One man told me the story of the fatal neglect of his father — after which the nursing home falsified his father’s records and hid behind state laws that nursing home lobbyists had written.

A former director of nursing at a long-term-care facility said that given her terrible professional experiences, she had refused to put her 78-year-old husband, who was suffering from dementia, anywhere outside her own home. Another clearly frightened woman explained that she had just had a horrible experience with her mother in a nursing home; she even gave me, a complete stranger, her phone number, in the desperate hope that I could raise the alarm about how bad things were.

We need to listen to people like this and act on what they are saying. The pandemic doesn’t have many silver linings, but as the number of nursing-home deaths piles up, the news media is being forced to cover a world many of us would prefer to ignore.

It is understandable that we would. Part of the price we pay for living in a death-denying, consumerist, throwaway culture is that we must push these kinds of grim realities to unseen places that afford us plausible deniability. The pandemic forces us to look. If we want to understand the current phase of the coronavirus pandemic, we can no longer look away.

After receiving this waterfall of messages, I expected to fall into despair. But while I do have my bad days, I also have hope. Times like this have produced major cultural changes in our past. If we do take a hard look, we may change more than just the way we treat older Americans. We may, along the way, find a way to push against throwaway culture in all its forms.

Instead of denying the reality of cognitive impairment, aging and death, could our culture begin to embrace it forthrightly in ways which lead us to honor the final years we have with the family members and friends who go before us? To honor the moral and social equality of every human being, regardless of their mental or physical status?

Why not? Many of us are staying home and practicing physical distancing, not primarily for ourselves but for the benefit of our elders and others who find themselves at risk. Let us build on that good and decent impulse by challenging a throwaway culture that, right up until this very moment, has marginalized these populations and made the nursing-home crisis a tragic inevitability.

In the early weeks of the coronavirus epidemic, the United States recorded an estimated 15,400 excess deaths, nearly two times as many as were publicly attributed to covid-19 at the time, according to an analysis of federal data conducted for The Washington Post by a research team led by the Yale School of Public Health. The excess deaths — the number beyond what would normally be expected for that time of year — occurred during March and through April 4, a time when 8,128 coronavirus deaths were reported.

The analysis calculates excess deaths by using a model to estimate how many people probably would have died absent the pandemic, and then subtracting that number from the overall deaths reported by the NCHS.

The excess deaths are not necessarily attributable directly to covid-19, the disease caused by the coronavirus. They could include people who died because of the epidemic but not from the disease, such as those who were afraid to seek medical treatment for unrelated illnesses, as well as some number of deaths that are part of the ordinary variation in the death rate. The count is also affected by decreases in other categories of deaths, such as suicides, homicides and motor vehicle accidents.

But in any pandemic, higher-than-normal mortality is a starting point for scientists seeking to understand the full impact of the disease.

The Yale analysis for the first time estimates excess deaths relying on data that the National Center for Health Statistics (NCHS), the analysis paints a picture of unusually high mortality that will come into sharper view as more data becomes available.

The analysis suggests that the deaths announced in the weeks leading up to April 4, based on reports from state public health departments, failed to capture the full impact of the pandemic. The analysis also suggests that the death toll from the pandemic is significantly higher than has been reported, said Daniel Weinberger, a Yale professor of epidemiology and the leader of the research team.

The national tally also shapes the public’s perception of how serious the disease is, and therefore how necessary it is to continue social distancing despite economic disruption. The figure has political implications for President Trump, who initially played down the threat of the virus and whose administration failed to ramp up covid-19 testing quickly, allowing the virus to spread undetected for weeks.

The problem of undercounting coronavirus deaths is not unique to this pandemic or to the United States. Insufficient testing is a major obstacle to understanding the scale of the pandemic.

Missouri might be the next state to allow video cameras in nursing homes.  Since the coronavirus has limited visitation, advocates are pushing to allow cameras inside nursing homes. With homes currently on lockdown, families are even more worried they can’t check in on their loved ones.

Legislators in Missouri conducted a hearing on whether to allow cameras inside nursing homes. Some people say its been a long time coming. So called “granny cams” are already legal in Illinois. A bill to allow them in Missouri already made it through the State House of Representatives and just needs to pass the State Senate.

“It’s important that we take care of our nursing home residents in all times, but really in this time,” said Marjorie Moore with VOYCE.

She says the coronavirus crisis has highlighted the need for cameras in nursing homes.

It’s a possibility that a person could be dropped and not picked up in a timely manner. There is a big possibility that call lights are not being answered in timely manners, dietary needs aren’t being met, things like that, and there is no one in there to monitor right now,” Moore said.

She’s worried seniors conditions will deteriorate because of lack of mobility or mental stimulation. It’s all an attempt, they say, to ensure seniors are getting the best care.

“It’s really important to have those cameras so families can really monitor that,” Moore said.

The nursing home industry has signed onto the bill. They would co-own the footage and both parties would have to agree before it’s released to anyone other than law enforcement.

As the industry seeks immunity, across the country, nursing home patients and their families have already started taking action against facilities that they say haven’t provided sufficient care during the pandemic. “Everybody is crying out, ‘Oh, this is an act of God. It’s a once-in-a-lifetime pandemic.’ Well, even acts of God and pandemics don’t give corporations a license to just completely abandon common sense,” says Dr. Roderick Edmond, a lawyer who is representing several families suing over COVID-19 deaths in an Atlanta assisted living facility.

Consumer advocates, industry watchdogs and personal injury attorneys say that providing legal immunity to thousands of private companies is dangerous. They contend the pandemic has exposed longstanding problems in the industry, such as staffing shortages and infection control violations, and that taking away its legal liability will make it harder to hold facilities to account now and in the future. “They’ve gotten to under-invest in infection control. They’ve gotten to under-invest in facility safety design. They’ve been allowed to stack people three to a room and four to a room,” says Matthew Cortland, a health care lawyer who is legally responsible for four people in a skilled nursing facility in Massachusetts. “Now instead of being liable for the pain and suffering that they’re causing, we’re going to bail them out with a liability shield? That’s a horrible precedent.”

I wonder why?

Private equity firms have also swooped in on the industry, and now control more than 15% of facilities nationwide, further slashing costs and taking steps to maximize profits over caring for the residents. When private equity firms take over nursing homes, a recent study by researchers at the University of Pennsylvania, University of Chicago and New York University found that they cut back on nursing staff, and these cuts are directly associated with declines in care standards and patient health.

In the past, the nursing home industry has hired Ballard Partners, the lobbying firm of Brian Ballard, a former top Trump fundraiser who started his lobbying practice once Trump won the White House. Ballard’s firm has earned more than $1 million in lobbying fees from the nursing home industry since 2017 as the Trump Administration has repeatedly made moves favorable to the nursing home industry.

During its first year, the Trump Administration limited penalties when they violate safety rules, switching from imposing a fine for each day a problem lasts to just one small fine for most violations—a move that resulted in a more than 30% drop in the average fine from the Obama Administration.

Despite the industry’s history of high number of infection control violations prior to the pandemic, CMS proposed removing a requirement that every nursing home employ an infection prevention specialist at least part-time to help eliminate “excessive administrative burden.” Instead, the agency would require that infection specialists spend “sufficient time at the facility.”

Nursing homes across the country have complained they’ve received faulty personal protective equipment from the federal government. Industry lobbyists are calling on VP Mike Pence to investigate multiple “failures” regarding PPE distributions.

I am asking you to personally investigate mounting evidence that FEMA shipments of PPE are deeply delayed, frequently stocked with useless and expired supplies, and delivered in quantities radically insufficient to help protect older Americans from the deadly coronavirus. Further, nursing homes across the country have not received clear and helpful communications about what to expect and when to expect it,” LeadingAge CEO Katie Smith Loan wrote to Pence.

She also cited instances where facilities either didn’t receive enough supplies or useless materials. A Washington official also described the supplies as “unusable” and “not suitable for nursing homes or for any other healthcare setting,” according to the report.

It is unclear if this is a failure of leadership, logistics, communications or all three. But for older Americans, the coronavirus is still ongoing,” she wrote.

Long-term care providers recently described receiving gowns that look like tarps with no holes for hands and surgical masks that were too thin, according to CNN. Nursing home giant Genesis HealthCare confirmed that two of its facilities received defective gowns.

“Our greatest challenge remains lack of widespread testing, adequate [PPE] and staffing support,” Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living, said. “We appreciate the renewed focus in prioritizing testing and PPE for nursing homes and assisted living communities, but more must be done. Lack of proper funding for these critical supplies puts our caregivers and the residents they care for at a severe disadvantage.”

Parkinson issued the comments following a hearing regarding nursing homes held by the Select Subcommittee on the Coronavirus Crisis. Several witnesses criticized the lack of investment in staffing and equipment for nursing homes which helped exacerbate the crisis in long-term care facilities.