Tag: Nursing homes

Blame Donald Trump for the nursing home Covid-19 crisis
The very first COVID-19 outbreak in the US took place in a Kirkland, Washington nursing home more than four months ago, at the end of February. At least 37 people died. That first outbreak should have been the impetus for the Trump administration to launch a coordinated national response to the COVID-19 pandemic, centered around protecting nursing home residents and workers. Instead, they’ve focused on protecting nursing home corporations from lawsuits.

When the White House brings up the nursing home crisis at all, it’s to seek to shift the blame to Democratic governors. Trump is desperate to deflect from the truth: Over 54,000 nursing home residents and workers are dead. Those deaths were preventable. Their deaths are Donald Trump’s fault.

A new report from the Senate Aging Committee lays out the Trump administration failures that led to the nursing home crisis. Trump never had a plan to protect nursing home residents. In fact, the actions his administration did take put seniors and people with disabilities directly in the path of the deadly pandemic.

For months, as nursing home workers faced a devastating shortage of personal protective equipment (PPE) and tests, Trump refused to invoke the Defense Production Act. Nor did he leverage FEMA’s response capabilities to target supplies to nursing homes.

An opaque and corrupt program, run by the president’s inexperienced, unqualified son-in-law, tasked to deliver critically needed PPE not surprisingly failed miserably to help anybody, except perhaps Trump’s political donors. FEMA continues to deliver broken and unusable equipment to nursing homes even as the unrelenting death toll in nursing homes grows.

Simply telling nursing homes to test workers and residents more often, as the administration has done, is meaningless. What’s needed is an actual plan to procure additional tests and get them to the facilities that need them. This late in the pandemic, that plan is still missing.

In March and April, Congress allocated $175 billion in emergency funding for health care providers in the front lines of the pandemic. It was the Trump administration’s responsibility to distribute that funding as quickly and efficiently as possible. But it took two months for the administration to distribute any of the funding to nursing homes—and then only a paltry $19.5 billion.

Nursing home workers are at the front lines of the crisis. Across the country, nursing homes have seen staffing shortages, forcing them to hire part timers who work in multiple facilities. Employees who remain are often forced to work while experiencing COVID-19 symptoms, further spreading the disease. This is exacerbated by the fact that even before COVID-19, private equity barons had seized on the long term care industry as a sector they could hollow out, carve up and destroy for profit.

We need to increase staffing levels by providing premium hazard pay. We must guarantee paid sick leave for all nursing home workers. Workers who need to quarantine should be provided with temporary housing so they don’t infect their families. The Trump administration has proposed none of this, because their anti-worker ideology takes precedence over public health.

The right-wing deflection operation is well underway. The Trump White House and Senator Mitch McConnell understand that the nursing home crisis is political kryptonite. They don’t care about the lives lost; indeed, they never mention them. Instead, they care only about the bad headlines and the plummeting support among seniors for Trump and Republicans.

Starting with the official propaganda organ of the Trump White House, FOX News, and filtering down through shadowy networks of dark money used to spread unchecked lies on Facebook, their playbook is clear: Deflect responsibility, blame Democratic governors, and lie about the failures of the president and his administration.

Chief White House strategist and mouthpiece Sean Hannity can be seen in this clip laying out the whole strategy for “dealing with” the nursing home crisis. Hannity heaps praise on Florida Republican Governor DeSantis while blaming, among others, Michigan Governor Gretchen Whitmer for her state’s nursing home crisis. He goes so far as to say that the media needs to apologize to Gov. DeSantis for criticizing his rush to “reopen” the state.

Like so much else Trump does, this strategy is based on a lie. Public health experts and local senior advocacy groups agree that Whitmer did a very effective job in a terrible situation, while Gov. DeSantis’s state of Florida is ineffectively confronting an explosion of new cases and dwindling hospital beds.

To end the nursing home crisis, we need a robust system of testing and tracking. We need a system in place to make sure that every facility has PPE, tests, and adequate staffing. We need measures in place to reduce the overall spread of COVID-19, including a national mandate to wear masks in public places. Most of all, we need an administration that values the lives of people over the profits of corporations.

Recently, one of Trump’s top economic advisors, Stephen Moore, suggested that we should allow every business (including high risk environments like bars and gyms) to reopen. He insisted this would be safe so long as we “keep older people in quarantine because they’re the ones susceptible from dying.” While Dan Patrick, Trump ally and Lt. Governor of Texas, another state with an exploding epidemic, said that seniors should sacrifice themselves to protect the economy.

It’s this cavalier attitude towards seniors’ lives that led to the nursing home crisis. Older people should not have to quarantine themselves forever, cut off from their families and friends, because the Trump administration is too incompetent to contain the pandemic. Nor would it even work for them to do so. Over 64 million Americans live in multi-generational households. And even if no nursing home patient ever left, or had visitors, workers still go in and out.

What Moore and Patrick are saying, and the philosophy behind Trump’s entire response to the pandemic, is that he thinks that seniors’ lives—as well as the lives of people with disabilities, people who are immunocompromised, and others who are at high risk from COVID-19— are disposable.

Trump’s failure to contain the nursing home crisis is a product of his values. He values nursing home corporations, which don’t want to get sued. He values Wall Street billionaires, who are demanding that every business reopen regardless of public health. He does not value seniors’ lives. He is more than happy to volunteer them to be sacrificed on the altar of Wall Street’s greed.

This is all Donald Trump’s fault. The blood is on his hands.

Here’s more from Just Care:
July 8, 2020
Coronavirus: How many more nursing home residents will die before the Senate acts?
Not only has the US not been able to contain the spread of the novel coronavirus, it has allowed COVID-19 to kill tens of thousands of vulnerable older adults and people with disabilities living in nursing homes. How many more nursing home residents will die before the Senate acts?

Here are the numbers: Every hour eighteen nursing home residents die. Every week, more than 3,000 nursing home residents die. In the last five months, more than 50,000 nursing home residents have died. When will this plague end?

Many of these mothers, fathers, sisters, brothers, aunts, uncles, friends and neighbors would still be alive today were it not for COVID-19. They’d still be alive today were it not for the failure of US leadership in containing the novel coronavirus. They’d still be alive today were it not for their nursing homes’ mishandling of the novel coronavirus.

Nursing home residents represent more than one in ten COVID-19 cases. Yet, four in ten people who die of COVID-19 are nursing home residents. In some states, nursing home residents represent more than half of COVID-19 deaths. And, these are the reported cases. Lord knows how many of these deaths are going unreported.

Tens of thousands of nursing home COVID-19 deaths were preventable. Everyone knew that nursing home residents were at especial risk because of their age and compromised health. Still today, with deaths skyrocketing, our federal government is failing to act.

President Trump and Senate Majority Leader Mitch McConnell (R-KY) won’t ensure that nursing homes have the money and resources needed so that their residents and staff are safe and healthy. They are focused on helping wealthy corporations, wealthy hospitals, and wealthy executives, including nursing home executives. The nursing home industry has a powerful lobbying machine that continues to be successful at protecting nursing home profits rather than nursing home people.

Nursing home owners, including many private equity firms, take government money for nursing home care to benefit their investors, leaving nursing homes without the funding to properly care for their residents or pay their staff. Nursing homes have been given immunity from prosecution on many grounds, notwithstanding preventable deaths among their residents and staff.

The US House of Representatives has passed the HEROES Act, which would protect nursing home staff and residents. The HEROES Act allocates money for testing and personal protective equipment. It sets aside funds for COVID-19 only nursing homes to isolate and contain the spread of the virus. These measures would help prevent nursing home residents from dying needlessly from COVID-19.

To be sure, beyond the HEROES Act, more must be done to protect older and disabled Americans, to ensure they have a good quality of life and can live with dignity. They need better quality care in nursing homes, and they need expanded Social Security benefits. For our collective health and our collective conscience, we must insist on that.

Here’s more from Just Care:
July 1, 2020
Coronavirus: Lawmakers ignore horrific number of nursing home deaths
David Dayen writes for The American Prospect on the horrific number of deaths at nursing homes during this novel coronavirus pandemic. At last count, more than 31,000 nursing home residents had died from COVID-19. What’s shocking is that lawmakers are turning a blind eye to the issue and protecting nursing home owners.

First, we have incomplete and inaccurate information about nursing home deaths. In fact, only four in five nursing homes have reported COVID-19 casualties to CMS. It’s unclear how many are misreporting their data.

At a minimum, one in four COVID-19 deaths are in nursing homes. To put that in context, nursing home residents represent fewer than one in 165 Americans. Dayen says that the number of nursing home deaths translate to between 12 and 18 deaths each hour.

This is criminal. Horrific. But, there is not the due uproar and focus on this scandal because it is largely hidden. We are not seeing the images to trigger the needed response. We only recently have seen data.

Meanwhile, states have imposed rules on nursing homes regarding testing of residents and staff to help contain the spread of the novel coronavirus. In some states, staff are expected to be tested twice a week. Some insurers are refusing to pay for these tests, which are related expressly to employment and not personal health. Nursing homes say they cannot afford to pay for them. Again, a guaranteed, universal health care system could easily address this issue.

On a separate note, lawmakers have given nursing home executives immunity from liability for failing to properly care for their residents. Nursing home regulations have been loosened. Fines for failing to abide by regulations have been lowered. Yet, many nursing homes have been cited for endangering their residents over the last decade, including improper care, abuse and theft of resources.

We have a terrible long-term care system in this country that is desperately in need of fixing. It’s long past time to start remedying this abhorrent situation.

Here’s more from Just Care:
June 9, 2020
Coronavirus is making it harder to get long-term care
The financial and emotional toll of caring for older adults has always been enormous. The novel coronavirus pandemic is making it still harder for caregivers attending to older adults living at home and, even more so, in nursing homes. Bob Herman reports for Axios on why long-term care has become an even bigger issue with COVID-19.

The data show that older adults are most at risk of becoming gravely ill or dying if they get the novel coronavirus. Many nursing homes and other long-term care facilities have been hard-pressed to contain the spread of the virus. The particular vulnerability of older adults if they get COVID-19 means added stress for them and the people who care for them.

The question becomes how to ensure older adults receive long-term care safely and affordably. Assisted living facilities and other group homes for older adults tend to cost a minimum of $4,000 a month. Medicare and private health insurance almost never covers their cost. Long-term care insurance will usually cover the cost, but it tends to be a bad investment.

Medicaid often covers the cost of nursing home coverage for people with low incomes and limited assets. In order for Medicaid to pay, people with more savings need to spend them. Depending upon the state you live in, your income may need to be very low. Also, many nursing homes are not safe and deliver poor quality care.

When choosing a nursing home, check out Nursing Home Inspect. Do not rely on Medicare’s Nursing Home Compare; it’s star-rating system is a farce. Kaiser Health News reports on how poorly many nursing homes do at controlling the spread of infections.

Increasingly, people opt for home care as a safer alternative. Over the last several years, more older adults are choosing to age in place, remaining in their homes and hiring home health aides or having friends and loved ones care for them.

But, aging in place can be enormously costly unless family or friend caregivers are able to help when needed. It also can be difficult to keep a paid caregiver. Wages tend to be low and turnover rates are high. And, in this time of COVID-19, having caregivers coming and going from the home of a loved one has its own set of risks.

If you are thinking of moving into an assisted living facility or other care facility, now is a hard time to consider your options. In person tours are limited at best. Virtual tours do not provide a 360 degree view of the facility. Unfortunately, it might still be several months before these facilities reopen.

Here’s more from Just Care:
May 27, 2020
Coronavirus: Should nursing homes be for-profit?
Matthew Goldstein et al. reports for The New York Times that most US nursing homes were losing money pre-pandemic. Not surprisingly, they were not well prepared for the novel coronavirus. The latest data indicates that one in three deaths from COVID-19 are nursing home residents or workers. Should nursing homes be for-profit?

Today, of the more than 15,000 nursing homes, about 70 percent are for-profit according to the Centers for Disease Control and Prevention. The majority of nursing homes are part of chains owned by companies trying to get as much money out of them as possible. In the process, they leave little money for patient care. A Kaiser Family Foundation report on chain nursing homes leads you to want to stay clear of them.

Often chain nursing home owners also own the nursing home real estate, which can be worth more than the nursing home. When they separate the nursing homes from their real estate, the nursing homes have less value and must pay rent. The nursing homes have fewer assets and less money to deliver care. Liabilities for these nursing homes can be twice their assets.

Nursing home owners often also own other companies that are vendors for nursing homes. That way, the owners can generate revenue from the nursing homes for their other businesses. The owners might not leave the nursing homes with enough money to care for their residents properly. The for-profit nursing homes have also been found not to deliver as good quality care as non-profit nursing homes.

A NYU business school report looked at private equity buyouts of nursing homes over 17 years. The researchers found a 2.4 percent decrease in nursing staff time and a 3.6 decrease in quality of care. At one facility, a nursing assistant reported that there can be as few as one certified nursing assistant for every 19 residents.

When the coronavirus struck, the for-profit nursing homes tended to be understaffed. And they did not have adequate personal protective equipment. This is likely why there have been so many COVID-19 deaths in nursing facilities. Still, many states are giving nursing homes broad immunity from lawsuits during this pandemic.

If you’re looking to compare nursing homes, Medicare rates nursing homes on nursing home compare based on a five-star system. You should avoid one- and two-star nursing homes. But, you should not assume that four- and five-star nursing homes deliver good quality care. The rating system is a farce; there’s plenty of gaming. Check out the Informed Patient Institute for more information on nursing home ratings as well as information on Pro Publica.

And, if you or someone you love is enrolled in a Medicare Advantage plan and needs nursing home care, beware. People in Medicare Advantage plans are likely to end up in lower-quality nursing homes.

Click on this New York Times link to see the number of COVID-19 deaths at different nursing home facilities.

Here’s more from Just Care:
May 12, 2020
Here are ways Congress can ensure the well-being of older adults during the coronavirus pandemic
Congress has just passed an $8 billion emergency spending package to help address the coronavirus pandemic. The emergency spending package includes funding to develop a new coronavirus vaccine. It also includes funding to states and localities for emergency stockpiles to respond to people’s needs. In addition, the Trump administration has expanded telehealth services for people with Medicare and is giving the states permission to loosen Medicaid eligibility requirements. As Congress works on a large stimulus package, Senators Jack Reed, Bob Casey and many other lawmakers have set forth a list of additional actions the federal government should be taking to ensure the well-being of older adults. It is fully captured in this bill introduced by Senator Bob Casey.

Congress should provide funding to cover the cost of automatically enrolling low-income older adults and people with disabilities in programs that help cover the cost of their premiums, deductibles and coinsurance. Today these Medicare Savings Programs are underenrolled, in part because people are not aware they are eligible. Enrolling them automatically will ensure that financial barriers do not prevent them from getting treated for the coronavirus and other health care needs.

Congress should make it easier for older adults to get tested and treated for the coronavirus and obtain the medicines they need. People should not forego care because of cost. Deductibles and copays should be waived along with prior authorization requirements. People should also be able to get 90-day supplies of their medicines and telehealth services. Whether you are enrolled in traditional Medicare or Medicare Advantage, you should have no out-of-pocket costs for testing. Medicare Advantage plans, including UnitedHealthcare, do not appear to be waiving out-of-pocket costs for treatment as of now.

Congress should increase funding to survey and inspect nursing homes. The Centers for Medicare and Medicaid Services needs money to inspect these facilities and ensure they have protocols both to prevent the coronavirus from spreading and to treat cases as they emerge. Right now, people in nursing homes are at particular risk of contracting the coronavirus because of lax infection control policies in many nursing homes.

Congress should provide states with additional Medicaid funds to help ensure low-income older adults have better access to home and community-based services. States could then hire more direct service providers and home health workers, pay them appropriately, and provide care to people currently on wait lists.

Congress should provide funding to Meals on Wheels and congregate meal programs to ensure older adults have healthy food to eat at home. Since older adults should be staying home as much as possible, they will not be as likely to be getting their meals at senior centers. Meals on Wheels also provides some companionship for older adults, an additional benefit that helps address social isolation.

Congress should increase funding for the Commodity Supplemental Food Program so that it can help more at-risk older adults.

Congress should provide funding to the National Family Caregiver Support Program so that it can help more caregivers. This program helps gives caregivers a break from their caregiving responsibilities.

Here’s more from Just Care:
March 18, 2020
Will nursing homes and assisted living facilities be able to keep the coronavirus from spreading to their residents?
Jordan Rau reports for Kaiser Health News that for quite some time nursing homes have not been following basic protocols to contain the spread of viruses and bacteria. The situation has only gotten worse since 2017. And, because assisted living facilities are not subject to government health inspection, we have no clue how well they do in containing the spread of viruses and bacteria.

Kaiser Health News found that more than six in ten nursing homes–9,372 nursing homes–have received citations from government inspectors for deficiencies in controlling infections. Those nursing homes with fewer staff had a greater likelihood of receiving a citation. It’s another reason to avoid chain nursing homes, which tend to have fewer staff.

When choosing a nursing home, bear in mind that the government’s star-rating system tells you very little about the quality of a nursing home. Forty percent of five-star nursing homes have been cited for infection-control deficiencies. Five people at Life Care Center of Kirkland, Washington, which has a five-star rating, have died of the coronavirus.

Facilities that have been cited for deficiencies often have workers who do not wash their hands each time they see a patient or do not wear masks or gloves when they are with contagious patients. These deficiencies can cause infections to spread.

Health inspectors treat these deficiencies as minor in almost all instances, so nursing-facilities have no incentive to change their practices. Only in 109 out of 13,000 citations were these deficiencies treated as serious threats to patients. Nursing homes with these deficiencies are generally not fined or penalized in terms of their star ratings. But, between the flu and MRSA or other antibiotic resistant bacteria, each year nursing homes have as many as 3.8 million infections which kill about 388,000 residents.

In some instances, staff who are sick do not stay home and infect other staff and nursing home residents. And, when staff stay home, it can sometimes be difficult for nursing homes to find replacement staff. There is a shortage of health care workers across the US.

As of 2016, the Centers for Medicare and Medicaid Services requires an infection preventionist–an employee in charge of infection control–to undertake training and work part-time or full-time in every nursing home. But, the Trump administration has proposed to do away with this on-site staff person. It wants the preventionist simply to spend “sufficient time” at a nursing home to oversee infection-control initiatives, whatever that means.

Here’s more from Just Care:
March 10, 2020
Medicare covers physical, speech and occupational therapy
Whether it’s because of an illness or an injury, or simply to improve balance, at some point in our lives, many of us will need therapy to regain or maintain our ability to function. Medicare covers physical, speech and occupational therapy in a variety of settings. Talk to the doctor about whether therapy would benefit you or someone you love.

Medicare offers several outpatient therapy options. You can receive outpatient therapy services at a Comprehensive Outpatient Rehabilitation Facility, hospital, public health agency or from a private therapist, so long as the provider is Medicare-certified and you qualify for coverage. You can also receive outpatient therapy services from a Medicare-certified home health agency, so long as you qualify for the Medicare home health benefit.

For Medicare to cover outpatient therapy, you must meet the eligibility criteria:
- Therapy must be a safe and effective treatment for you.
- A therapist must deliver the services or direct the delivery of the services.
- Your doctor must certify you need the therapy to regain or maintain your ability to function and set up a plan of care for you in advance of your receiving services. And, if you need ongoing therapy, your doctor must review it and recertify your need.
Medicare now covers as much outpatient physical, speech and occupational therapy as people need.

Traditional Medicare pays 80 percent of the cost of these covered services. Supplemental coverage, such as Medicare supplemental insurance or “Medigap,” retiree coverage or Medicaid, should pay the rest.

Medicare also offers several inpatient therapy options. It covers physical, speech and occupational therapy in a nursing home as well as in a rehabilitation hospital. Coverage is limited. If you want inpatient care in a nursing home, you will need to have been hospitalized as an inpatient for at least three days in the 30 days prior to admission. You must receive care in a Medicare-certified skilled nursing facility. (Note: You can spend three nights at a hospital and the hospital may still deem it an outpatient stay.)

If you simply need rehabilitation services–be it nursing, therapy, social worker help or psychological services–Medicare will cover care in a rehabilitation hospital under its hospital benefit.

Medicare also covers cardiac rehabilitation care. Click here to read more about this coverage.

Here’s more from Just Care:
January 13, 2020
Assisted living facilities present serious risks for some people
In a New York Times op-ed, Geeta Ananad warns against expecting assisted living facilities to meet the needs of aging parents once they lose their independence. Rather, she explains that assisted living facilities can present serious risks to older adults who are not able to function independently.

To be sure, most people have no desire to end up in a nursing home, even if they offer 24-hour care. Ananad argues that an assisted living facility is not a substitute. Most of us will not be self-reliant until the day we die. And, if we cannot care for ourselves, we likely should not be in an assisted living facility.

Don’t believe the marketing hype about assisted living facilities. They appear to be a good financial investment–with close to 15 percent annual returns, of late. But, assisted living facilities likely are not where you want your parents, or for that matter yourself and the people you love, to live out their lives.
Assisted living facilities have the advantage of offering older adults companionship, activities and social interactions that they often cannot get at home. As you need more care, however, it becomes harder to rely on an assisted living facility, as much as you might like to. Once you need help walking or toiletting, or become mentally impaired, assisted living facilities are generally ill-equipped to meet your individual needs.

Half of assisted living facility residents are over 85 and more than four in ten have dementia; they need fulltime attention, which is generally not available to them. For most people who are not independent, the “24-hour” monitoring an assisted living facility offers is not enough to provide needed assistance and to ensure people are safe. According to Eric Carlson, the directing attorney for Justice in Aging, the assisted living facility system is broken.

Unlike with nursing homes, the federal government neither licenses nor oversees assisted living facilities. And, states do a poor job of regulating them. Assisted living facilities often do not have adequate staffing or properly trained staff and generally are not even required to have medical directors to review care for patients. (NB: Nursing homes must be licensed and meet strict regulatory standards and still they too often do not deliver the care people need.)

The average cost of staying in an assisted living facility is nearly $6,000 a month. The cost will only increase if regulations require more staffing and more trained staff.

Ananad proposes a Japanese model for paying for long-term care–a mandatory national long-term care insurance system, which the government helps pay for and is also supported by payroll taxes and premiums. Better still, Medicare for All, a single-payer cost-effective universal health care system, would spread the cost of long-term care across the entire population.

Here’s more from Just Care:

Housing options for older adults

Beware of chain nursing homes

Medicaid coverage of home and community-based care

PACE helps older adults stay in their community

Aging in place: Safety at home
September 4, 2019
Choose your hospice carefully
The HHS Office of the Inspector General just issued two scathing reports on the Medicare hospice program. It found that nearly one in five hospice agencies suffered from serious deficiencies that put patient health and safety at risk. And more than four in five had at least one deficiency. Choose your hospice carefully.

The Medicare hospice benefit can be extremely valuable to patients who choose palliative or comfort care rather than curative care at the end of life. Usually, care is provided in the person’s home. But, it can also be provided in an assisted living facility or skilled nursing facility. Some hospices have their own hospice inpatient unit.

But, not all hospice care is the same. We do not know which specific hospice agencies the OIG found suffered from serious deficiencies or how many of the 1.5 million Medicare patients in hospice are endangered. The OIG examined only a small number of cases. It described a case in which a dying man’s feeding tube had maggots growing on it. And, it reported on a patient with Alzheimer’s going without appropriate wound care, which caused her to need her leg amputated.

The Centers for Medicare and Medicaid Services (CMS), however, apparently does not have adequate authority to hold these companies to account when they cause harm to patients. CMS’ only available penalty is to end its contract with hospice agencies, which CMS has not chosen to do. Consequently, hospice agencies can cause harm to patients with apparent impunity. The OIG recommends that CMS have greater legal authority to penalize these hospice agencies.

The OIG recommends Congress give CMS the authority to impose fines on hospice agencies, authority CMS already has for nursing facilities. That said, CMS does little to use that authority with nursing homes. And, why is CMS not simply terminating contracts with the facilities that put patients at risk because of their serious deficiencies?

Moreover, why isn’t CMS flagging the agencies that have serious deficiencies on Hospice Compare, a government tool to help people choose a hospice agency. CMS has chosen not to publish state agency reports showing deficiencies because “they may be misleading.” CMS claims that state reports on hospice violations should not be available on Hospice Compare. As of now, survey reports from accrediting organizations, such as NCQA, the National Committee for Quality Assurance, cannot be publicly disclosed. But, that may change.

CMS argues that Medicare-certified hospices are required to meet federal health and safety standards that keep patients safe. But, it clearly is not ensuring that they do. Before you choose a hospice agency, do your homework. Check with your state to learn about deficiencies the state has found with hospice agencies.

Here’s more from Just Care:
July 24, 2019