PRESIDENT TRUMP “KILLS ELDERLY” BY DEREGULATING NURSING HOME INDUSTRY AND ENDING LAWSUITS AGAINST NURSING HOMES

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They’re killing us softly, like frogs in a slowly boiling pot. Every day it gets harder for those born into my generation to get a break in our little battle for what we call life. We struggle head-on with the economy, our health, Western medicine, the pharmaceutical industry, corporate profits, GMOs, chemtrails, Smart Meters, 5G cell towers, geo engineering, firestorm terrorism, “fake news,” and those with different views in what is seemingly a never ending assault on all senses that promises to change all that is, us included, in dramatic fashion.

The state of the health care nation for our elderly grows darker by the hour. This is again evidenced by the Trump Administration that has scaled back the use of fines against nursing homes that harm residents or place them in grave risk of injury. This is a “reversal of guidelines put in place by President Obama,” writes Jordan Rau of Kaiser Health News.

Not surprisingly, it was the nursing home industry itself that requested the changes to the Medicare program’s penalty protocols, saying that relief was “critical”. The nursing home industry’s central trade group, the American Health Care Association, the Kaiser article says, had complained to the Trump Administration that government inspectors excessively focused on catching wrongdoing rather than helping nursing homes to improve. Where some people come from, this is called deterrence. And isn’t deterrence the whole point of nursing home regulation? To deter abuse and neglect by health care facilities whose operators are focused on the bottom line — budget cuts disguised as shareholder profits.

Since 2013, nearly 6,500 nursing homes — 4 out of every 10 — have been cited at least once for serious violations. “Medicare has fined two-thirds of those homes,” Rau writes. “Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.” And so we’re going to just cut that oversight, right? Avoidable accidents, neglect, mistreatment and bedsores be damned!

The new Trump guidelines discourage federal regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines are expected to result in lower fines for many facilities. “The change in federal policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business,” the Kaiser article says. Many facilities are going to be saving money as well by not having to pay stiffly appropriate fines.

The change in federal policy also aligns with health care providers’ argument that they have been spending too much time complying with regulations that they say get in the way of providing health care for their patients. What they don’t say is that paid nursing home employee time spent attending to oversight regulators also takes profit from shareholders’ mouths.

WHOSE LIFE IS IT ANYWAY?

Statistics say there are 1.3 million Americans living in nursing homes today. This number seems very low. According to Morning Star, by the year 2020, 40 percent of all deaths in the United States will take place in nursing homes. So is dismantling federal regulations in this industry really something we who represent aging baby boomers want to do? Who is protecting the seniors interests in health care that doesn’t kill them? Do seniors really have to go to nursing homes to suffer, be drugged, and die? How many caregivers do we need to accomplish this?

The federal guidelines that were put into place in 2013, which increased fines for nursing home actions that harm or even kill patients, were reversed. The oversight and imposition of fines were intended to encourage nursing homes to toe the line and meet the high standards. With the Trump Administration guidelines, however, regulators are discouraged from levying fines in many situations, some that have even resulted in deaths of the residents.

According to the Kaiser article, Senior attorney at the Center for Medicare Advocacy, Tony Edelman, confirms, saying: “They’ve pretty much emasculated enforcement, which was already weak.” The article cites a Kaiser report of one nursing home patient who died because of staff failure to monitor and treat a wound. Under the 2013 guidelines, the nursing home was fined almost $300,000. Under Trump’s new guidelines, the maximum fine would have been less than $21,000. That’s a $279,000 windfall for corporate shareholders to divide among themselves.

RESIDENTS WAIVE RIGHT TO SUE IN COURT

To make matters even more difficult for Alzheimer’s patients and wheelchair bound elderly, for decades patients and their families have been prevented from legally redressing their grievances by suing nursing homes even when they were guilty of egregious negligence or abuse. The nursing homes ensured this by making people entering the facilities sign contracts requiring them to settle any future disputes through arbitration.

The Obama Administration had barred nursing homes from this practice, protecting the rights of residents and their families to take nursing homes to court. However, the Trump Administration not only threw out this protection, says The New York Times, it has proposed a federal rule change to affirmatively allow nursing homes to bar residents and their families from filing lawsuits.

Again, there has to be a group that truly represents the seniors’ interests. Here, the issue seems quite clear. Those seniors who live in health care facilities are doing so because they have no other choice in life. Many of them have suffered severe health ailments that have rendered them wheelchair bound. Many of those who are disabled physically also suffer from major mental and emotional issues that are related in cause and origin. True science has proven that Alzheimer’s, Parkinson’s, and other neurological diseases are tied to physical deterioration of the cells of the body. In other words disease of the mind originates from a diseased body. In mind as in body.

Many of these disabled seniors have no money and rely on government to protect them from negligent and abusive caregiving. Their families don’t have the money to take care of their beloved seniors. So family members have no choice but to commence searching for a nursing facility that will even admit their senior loved one. When they get accepted, under the Trump Administration suggested policy, the seniors’ family would have to sign a waiver saying they can never sue the nursing home no matter what kind of abuse or neglect they do to a loved one. Regardless, burdened family members who have run out of energy, money, and options on how to care for their senior loved one will jump at the chance to hand their mother or father over to a nursing facility and breathe easier as a result, believing someone else has relieved them of the responsibility of providing direct health care.

BOTTOM LINE IS MORE LEGISLATION NEEDED TO AID GROWING NUMBER OF SENIORS

Here’s the bottom line. Elderly citizens confined to nursing home care are not getting the protection they need from bigger institutions that are supposed to provide their health care. Deterrence for the nursing home industry to comply with adequate standards is being squandered by government and the corporations that play banker investment games for profit with the nursing homes that care for the elderly across the country.

New, more meaningful legislation appears to be the only adequate fix to the glitches in the present health care laws. We will also need to appropriate the necessary funding in government health care budgets to allow for zealous regulation of the home nursing industry and then to legislate unbiased bi-partisan supported laws with crocodile sharp teeth that will hold the operators of American nursing homes, and the shareholders who climb into corporate board of directors’ heads to maximize profits, accountable for every misstep they take in caring for each and every nursing home patient. Only then will we begin to relieve the suffering of those who require nursing home care, because the industry will then be appropriately regulated, and the penalties for negligence and abuse will be too steep a price to pay for disobeying the law.

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SENIOR CITIZENS SQUEEZED BY NURSING HOME PROFITABILITY AND CALIFORNIA LAW REQUIRING MORE CARE FOR ELDERLY

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There’s no question it takes a special kind of person to provide compassionate care for the elderly. Bathing, feeding, medicating, attending to other daily needs of patients is a lot to ask for from the me now generation. Care giving for the elderly takes a lot of energy and thoughtful attention. There is tremendous value for this kind of work for the elderly in today’s society. But it doesn’t pay very well, which begs the question: Where does the position of caregiver for the elderly fit in the overall structure of today’s generation of aging baby boomers and broken millennials?

We’re not spending a lot to pay for difficult work like nursing care, that much has been established beyond doubt. Stressful work and low wages is a difficult combination to overcome during a questionably down-turning economy, but that, according to one group, is what we’re facing in our fight to protect the rights of our growing geriatric population.

They say our elderly citizens who require nursing care need qualified caretakers. Yet, it takes money to find someone who knows how to care for seniors and to be able to pay them, and the entire industry is scrambling for the almighty dollar that it takes to do so.

Latest available state data indicates CNAs are undervalued in the industry. Certified nursing assistants in California made an average of $13.96 per hour in 2016. That’s just a few dollars above the minimum wage and less than what some retailers pay sales clerks, who don’t need to spend the money or time getting licensed to work.

In a July 13, 2018 article for the Los Angeles Times, Ethan Millman describes how elderly healthcare matters in California have become hostage to this nursing home drama which is attributed to new state legislation that went into effect in July that puts even more “pressure on the state’s 1,000-plus nursing homes”, Millman writes, “which some in the industry say could be forced to turn away or even discharge patients as a result.”

ARE YOU KIDDING ME? OR IS THIS A BLUFF BY THOSE WHO RUN PRIVATE NURSING HOMES?

The new law tightened staffing requirements for direct caregivers and added new ones specifically for certified nursing assistants. Millman cites the new legislation as being championed by organized labor and patient advocates.

Under that scenario, we’d have the union representing nursing assistants, which pushed for the law, acknowledging that nursing homes face a challenge, but saying there is an overriding health-and-safety issue behind the new legislation. “There must be enough direct care staff to meet the quality care needs of nursing home residents and ensure a healthy workload for every caregiver,” Millman quotes an unnamed SEIU representative as saying.

The problem with this angle of course is that it places undue emphasis on the value of a CNA in this particular equation. The beginning of the statement is true — “There must be enough direct care staff to meet the quality care needs of nursing home residents,” period. Nobody of sane mind could conclude otherwise. We need better care for our seniors, and we must figure out how to pay for it. Whether every caregiver has a healthy workload or not is up to the caregiver’s skill set versus the demand for such a skill set in the everyday industry marketplace, and it’s a problem for the CNAs union to deal with, not state health care legislators. This aspect has nothing to do with the well being of the nursing home resident, whose need for quality care giving is being debased in the debate.

QUALITY OF CARE EQUALS QUALITY OF LIFE

As the new legislation reads, effective July 1, 2018, California Health and Safety Code section 1276.65 requires skilled nursing facilities, “except those skilled nursing facilities that are a distinct part of a general acute care facility or a state-owned hospital or developmental center,” to provide 3.5 hours of direct patient care each day, which is up from 3.2 hours. That’s 3.5 hours per day that the nursing facility caregiver has to directly care for a patient.

But what stresses out nursing home operators the most, and what seems to be the central theme of Millman’s writing, is California law’s first-ever requirement that “skilled nursing facilities shall have a minimum of 2.4 hours per patient day for certified nurse assistants.”

That means 2.4 hours of the 3.5 direct care hours per patient day must be filled by CNAs. And so the L.A. Times article is framed front and center around the nursing home gripe. Certified nursing assistants cost money. They have to be trained. Profits are shrinking. The big bad wolf is blowing down our door. What the article doesn’t tell us is that monies not spent toward better patient care get deposited into shareholders’ bank accounts, and that’s really the rub of this whole picture.

PRICE INFLATION HAS NOT HIT THE NURSING INDUSTRY

The Los Angeles Times article has framed this issue as a battle between the government enacting the law to provide more skilled health care to nursing home patients versus the burden it places on nursing homes to provide CNAs to fill the required hours.

The article portrays the nursing home industry as being in a quandary with the new legislation because, industry consensus says, it is difficult to get qualified CNAs to begin with, and now the requirement of 2.4 hours by a CNA is too tremendous a burden on the industry, especially in less populated rural counties. They say half of California’s counties are designated by the Public Health Department as having a CNA worker shortage.

The nursing home industry, through the Los Angeles Times article, sets up the CNAs as the tipping point of much broader issues. These are the men and women who work the front lines in home nursing, dealing hands-on with our wheelchair-bound seniors, those we pay privately and with tax dollars to give compassionate care to our elderly parents, friends, and relatives, yet price inflation has not hit those employed by the nursing home industry the way it has the rest of the economy, and we’re not getting our money’s worth. And who’s going to pay for it most?

QUALIFIED CNAS ARE SCARCE

When one studies what’s plaguing the home health care industry the areas for concern become obvious. Low wages and a high-stress working environment are not an attractive combination to offer a hungry, caring job seeker. When you add the prospective CNAs being required to take 100 hours of clinical training and 60 hours of classroom instruction, people are going to be looking for other types of employment.

They’re not going to take the time and expense to receive training through what amounts to be about 700 state-wide programs, many that are offered at community colleges, adult education programs, and for-profit schools, with most charging several hundred dollars to complete. Most people don’t have several hundred dollars or the time and inclination to make the effort to become a CNA. They can’t afford to.

Then you add the fact that nursing homes have just plain eliminated free in-house training to recruit workers basically because profits are down. No one has the money to pay anybody for anything. The nursing home industry cites tighter budgets. Those who want to become CNAs don’t have the money to go through the education and training to become CNAs. And senior citizens, their families, and the government don’t have enough money to be able to afford nursing home health care for seniors to enable them to spend the last months, weeks, or days of their lives in a compassionate and dignified manner.

THE NURSING HOME INDUSTRY CITES TIGHTER BUDGETS, BUT NEEDS TO LOOSEN PURSE STRINGS

This is the crux of the issue centering the problems cited by Millman. Nursing homes are owned by corporations owned by their shareholders. The list of corporations owning care facilities across America is short and those that do are locked in a dog-eat-dog battle to the death with each other and converging industries to suck in what dwindling profit margins there are left. Mergers and acquisitions are rampant in all areas of health care.

Who has time or resources for patients? The nursing home industry is making across the board cuts in staffing, training, and compassionate care for their senior residents. This is happening across the country as evidence mounts that those who own nursing homes should be loosening their purse strings and offering training and better care at their rural facilities, because their senior residents are suffering at an alarming rate as a direct result of their industry-wide, self-imposed budget cuts.

UNCLE SAM NEEDS TO LOOSEN HIS PURSESTRINGS AND COVER THE COSTS OF HEALTHY HEALTH CARE

Nursing homes come in all shapes and sizes. Some are more upscale and receive private pay for income, with much of the rest coming from Medicare.

In California, the majority of nursing homes draw more than half their revenue from Medi-Cal, the state program that provides health services to low-income residents, which the industry complains doesn’t cover the cost of care.

This only exacerbates the shameful problem that pay isn’t high enough across the industry to provide for adequate and dignified care giving for our ailing senior citizens. Both private nursing home providers and government health agencies must be willing to budget more money into healthy health and nursing care for seniors. Private care facilities, many of which are run through giant real estate trusts or conglomerates, must find a way to operate their holdings to actually benefit those who seek their services. A new model in the way of doing business industry wide is mandatory, or they are simply going to go out of business. Nobody can afford their poor service.

CONCLUSION: CALIFORNIA SENIORS ARE TAKING A BRUTAL HIT

The proof is in the pudding. Just ask the California state auditor who singled out the California Department of Public Health for scathing criticism regarding skilled nursing facilities and their lack of performance of necessary “inspections or issued timely citations for substandard care.” They cite absent effective oversight and substandard quality of care, a deadly combination. This apparently means the reason the nursing home industry continues to fail our seniors is because the government isn’t doing its job by monitoring them adequately.

The California governmental agency responsible for nursing home operators rightfully took a hit for having allowed poor care to proliferate at nursing homes around the state, with the number of incidents that could cause serious injury having increased significantly in recent years. The California state audit concludes that the California Department of Public Health’s failures in oversight increase the risk that nursing facilities may not provide adequate care to some of the state’s most vulnerable residents. Safety and accountability problems at nursing homes across the United States are rampant, says the California State Auditor.

Federal inspection reports show that infection control is routinely ignored in nursing homes across America. To exacerbate matters, the Trump Administration has scaled back the use of penalties to punish nursing homes that put residents at risk of injury. This compounds the issue cited by the audit where in a vast majority of cases government investigators found problems that could severely harm patients, the public health department failed to cite or fine the facility involved. Who’s watching out for the seniors?

It is disturbingly clear that the public health department in California is not holding nursing homes accountable for what amounts to be crimes against the elderly. Neglect can be criminal. The government needs to regulate this industry. It also needs to make sure there are enough beds in nursing homes that can be attended to for 2.4 hours per patient day by a registered CNA, and 3.5 total hours of direct skilled attention each and every day. Government health agencies and the nursing and home care industry are going to have to be brought together in the most unlikely of marriages, or a large segment of our growing numbers of senior citizens is going to dwindle and suffer at a much greater rate than is necessary.

LAWMAKERS DEMAND DAMAGING SECRET VA NURSING HOME DATA BE RELEASED TO PUBLIC

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Darkness is coming to the surface for senior healthcare. In this instance it’s the Veteran’s Administration, where VA internal quality data documents that were obtained in a USA TODAY/The Boston Globe investigation reveal for the first time that VA nursing homes performed worse on average than private nursing homes on a majority of key measures, including:

  • Reported pain in the last five days
  • Received anti-psychotic medicine, which the FDA has associated with an increased risk of death in elderly dementia patients
  • Experienced marked decrease in abilities to perform daily activities like bathing, eating, and using the bathroom
  • Had a catheter left in their bladder, which can lead to urinary or blood infections and other complications
  • High-risk residents with serious bed sores, which may be prevented by repositioning/cushioning

As a result, several members of Congress have demanded that the Department of Veterans Affairs release a full complement of nursing home data that the agency has kept hidden from public scrutiny for many years.

Donovan Slack of USA TODAY and Andrea Estes of The Boston Globe write at bostonglobe.com that the VA pushed back by downplaying the contrary findings and calling the story “fake news”.

Yet to be released data includes the VA’s underlying quality data, such as rates of infection and injury. Several lawmakers have called for the release of the information immediately.

In a June 18, 2018 article at usatoday.com Slack and Estes describe one of the worst ranked VA nursing homes in the U.S., a place where American veterans are sent by family members in belief they would receive more specialized care, only to find they’ve been turned into “zombies” through the administration of too many anti-psychotic drugs accompanied by too little personal care.

The agency has tracked detailed quality statistics on its nursing homes for years but has kept them from public view, depriving veterans of potentially crucial health care information, the article says.

VA officials argued that the VA nursing home system, overall, “compares closely” with private nursing homes despite caring for typically sicker residents.

The VA’s hospitals have drawn intense criticism for repeated scandals involving health care in recent years, including preventable deaths, but the agency largely has operated its nursing homes with scant public scrutiny.

Internally the agency has long monitored care at its nursing facilities through quality indicators and unannounced inspections and, since 2016, through star rankings based on the indicators. Until now, the USA TODAY article says, it has kept all of these quality measures from the public eye.

Under federal regulations, private nursing homes are required to disclose voluminous data on the care they provide. The federal government uses the data to calculate quality measures and posts them on a federal website, along with inspection results and staffing information. The regulations do not apply to the VA. This information is not available to the public who are in the market looking for veteran’s homes.

But darkness is turning to light. The USA TODAY/The Boston Globe article quotes VA press secretary Curt Cashour as blaming the Obama administration for resisting making quality data public. “But under President Trump’s leadership,” the articles quotes Cashour from a June 12, 2018 statement,” transparency and accountability have become hallmarks of VA.”

Both the Republican-led House and Senate VA committees requested briefings from VA officials following the damning report. Transparency and accountability is what’s coming to the United States Department of Veterans Affairs, then the “fake news” won’t matter.