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Everyone’s nightmare: Jamesville nursing home fined $16,000 over abuse

Nursing Home/Day Care Center

I don’t know what’s worse: Putting your parent in a facility where you have to worry, or being the person who’s trapped in an abusive facility:

The state of New York recently fined a Jamesville nursing home $16,000 for failing to protect residents of the home from being sexually abused by other residents.

The fines were a result of a state inspection conducted at the Iroquois Nursing Home last April where it was discovered that the facility failed to protect other residents in the dementia unit from two male residents who had histories of sexually abusing and being aggressive with other patients. The two men also had histories of abusing staff.

According to the report, in a 30-day period, one of the men exhibited aggressive, inappropriate, and sexually abusive behavior at least ten times.

Experts on nursing homes say they are seeing an alarming increase in these types of cases. Data from the New York Health Department appear to confirm that, with at least six substantiated cases of resident-on-resident sexual abuse over a three-year period.

There have also been multiple studies conducted on this serious issue. Cornell University conducted a study that surveyed over 2,000 nursing home residents in 10 homes throughout the state.

The study found that one in five nursing home residents had been a victim of at least one aggressive and negative encounter with other residents in the prior four weeks.

Nursing home residents who are a threat to other residents and staff usually suffer from some type of mental disability – such as Alzheimer’s disease – but are still physically able to get around.

One of the major causes of these incidents, experts say, is that many of these facilities are understaffed, leaving some of the most vulnerable members of our society unprotected.

Upon hearing of the fine the nursing home received, the third largest in the county in the past 10 years, Richard Grungo commented, “It is the duty of every nursing home facility to protect its residents. When families place their loved ones in a home, they expect – as they should – that their loved on will be well taken care of and protected. These cases of resident victimizations are unacceptable.”  

CBO score: ‘Only’ 22 million left uninsured

Oh, yay.

WASHINGTON — The Senate bill to repeal the Affordable Care Act would increase the number of people without health insurance by 22 million by 2026, a figure that is only slightly lower than the 23 million more uninsured that the House version would create, the nonpartisan Congressional Budget Office said Monday.

Next year, 15 million more people would be uninsured compared with current law, the budget office said.

The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.

The release of the budget office’s analysis comes as a number of reluctant Republican senators weigh whether to support the health bill, which the majority leader, Mitch McConnell of Kentucky, wants approved before a planned recess for the Fourth of July.

It just seems a little crazy to me to put desperate people with guns in this situation. You know?

What happened to California single payer?

From mRally to Save Medicaid Chicago 6-6-17 0548y friend Nicole Belle on Facebook:

I feel a bit of a rant coming on. Bear with me.

Before I begin, I must provide my caveats: I am a full supporter and big believer that the ONLY answer to healthcare in this country is to migrate to a single payer system. I am an unapologetic liberal and not a neo-liberal shill (and I’m willing to bet money you couldn’t define that anyway) I am not paid by Big Pharma, any insurance agency, special interest group or George Soros. If these are your retorts to what I’m about to write, just move along, this is grown up time and I don’t have time or energy to deal with tantrums.
That said….

I need liberals to take a deep breath and calm down about single payer in California.

It is disappointing to know that AB #562–the “single payer bill” in California has been shelved. It has to be said: this may not be a permanent situation.
HOWEVER, California Assembly Speaker Anthony Rendon decided that the bill–as written–was “fatally flawed” and has decided to not bring it out of the rules committee. It should be mentioned that Rendon is on record as being supportive of single payer. He’s said that he thought California should be a leader for the rest of the country.…/la-pol-ca-essential-politics-updat…

But here’s where the rubber hits the road. There is a deep and fundamental difference between supporting a concept and actually being responsible for putting together the infrastructure to make a workable program. I fully support the concept of ending racism and sexism in our time. How to actually accomplish that is where things get a little fuzzy.

Moving a state as populous as California to single payer requires the coordination of a fuckton of moving parts. And unfortunately, AB #562 didn’t give specifics on how to get that accomplished. I personally talked to some of the activists on how they thought it would work in terms of delivering the health care. They responded by talking about taxes. No, no, no. I grasp that we’re going to pay higher taxes (although I thought some were fairly flippant about that. Right now, my husband and I pay our 18 year old daughter’s insurance through our private policy–under a single payer plan, that would be taken out of her paycheck in taxes, effectively leaving her little to no discretionary income. How many struggling minimum wage workers in this state would be in the same boat?), and honestly, I’m fine with paying higher taxes because this is a program I think should be done for the greater good.

But I’m talking about actually getting health care. Is it an expansion of MediCal to everyone? Does that mean that doctors in the state HAVE to accept those capitated rates? (A lot of doctors don’t accept MediCal patients). What’s the policy for experimental procedures? What’s the policy for support procedures (physical therapy, acupuncture, etc.)? What’s the maximum allowable time for health checks (presumably urgent care remains same day, but is it acceptable to have a three month wait for a physical?)? What about hospitalization, hospice, palliative care? Does it also include mental health and dental services? What’s the prescription reimbursement rate? What has been negotiated with the existing health insurance industry in the state to make sure that we’re not creating an economic crisis by putting people out of work? Are we going to adopt the basics of MediCal or are we going to have a more robust system like private insurances/ACA?

Who makes these decisions? Who continues to manage the program? Who sets up this infrastructure? Who handles billing and payment? I don’t know specifically what the fatal flaws are in this bill, but I would think that smart liberals actually dedicated to bringing single payer to California would want to know what they could do to fix it rather than stomping their feet and throwing accusations of corruption around.

These things take a lot of thinking and planning to make happen. The answer is not “Well, every other country does this, so why don’t you want it? Are you paid off by Big Pharma, you neo-liberal shill????” Every country does it differently. We need to figure it out.

And that doesn’t even take into account the current political climate. The GOP appears to be specifically punishing blue states in their awful Trumpcare plans (…/republicans-included-sneaky…/). This bill is ALREADY proposing a program that is twice the state’s budget already (yes, you read that right:…/california-single-payer-health-care-e…).

What happens if California starts getting less federal payments as punishment? What programs start getting hit then? How will that hurt Californians, especially the most vulnerable of us?

Again, I WANT single payer.

But I want a program that will make sense and will work. Last November we had a proposition that was supposed to lower our pharma costs. Liberals touted that proposition, Bernie did ads for it. But I read the language of the bill and asked other health care experts about it as well. It was written so poorly that it actually would have ended up costing us MORE money, not less. Thankfully, the proposition failed here. Maybe, just maybe, that’s the same problem with AB #562. I honestly don’t know, but the material point to all the liberal blogs screaming “corruption” is THEY DON’T EITHER.

Full credit for wanting to show that single payer should be the law of the land. But now, rather than alienating potential allies by assuming bad faith, why don’t we find out WHY the bill has been shelved and how it can be addressed?

Waiting on Mitch’s Healthcare Bill …

Today is the Mitch McConnell says the text of the Senate ACHA bill will be revealed. After the unveiling of the bill, we will have to wait until next week for a CBO score. The Senator’s goal is to have a bill through by the break for the Fourth of July holiday.

U.S. Senate Republicans plan to unveil the text of their draft healthcare bill on Thursday as senators struggle over issues such as the future of the Medicaid program for the poor and bringing down insurance costs.

Republicans in the chamber have been working for weeks behind closed doors on legislation aimed at repealing and replacing major portions of the Affordable Care Act, former Democratic President Barack Obama’s signature healthcare law, popularly known as Obamacare.

The effort has been plagued from the start by tensions between moderates and conservatives, which surfaced again on Tuesday. Democrats have also criticized the behind-the-scenes meetings, staging a protest on the Senate floor on Monday.

“Republicans are writing their healthcare bill under the cover of darkness because they are ashamed of it,” Senate Democratic leader Chuck Schumer charged.

Many Senators have expressed that they do not know what is in the bill. It is believed that a group of 13 Republican Senators has been working in secretive, closed-door sessions.

Here is what is known to be in the bill…

The bill is expected to repeal the biggest parts of the Affordable Care Act, including the individual mandate and the employer mandate. It is also expected to defund Planned Parenthood for one year by kicking the women’s health organization out of the Medicaid program. That provision could be dropped if Senate Majority Leader Mitch McConnell needs votes from key moderates who oppose it….

It would eliminate Obamacare’s subsidy program and replace it with a different structure to help low-income people afford insurance. But Republicans are still trying to craft an alternative that would prohibit coverage of abortion without violating the strict reconciliation rules enabling them to pass the bill without a Democratic filibuster….

The bill is also expected to dramatically reshape Medicaid. Instead of an open-ended entitlement, states would get a set amount of money per person. In a win for conservatives, the Senate is expected to cut the program as aggressively as the House did until 2025 or 2026 and then make payments that grow in line with inflation. States are expected to have significant new flexibility for how they run their Medicaid programs. Republicans are likely to include a carve-out for certain children with complex medical needs, according to several sources…

The bill is expected to repeal Obamacare’s taxes, but how soon that is done is fluid because it would likely depend on how much tax revenue is needed to cover other costs associated with the GOP plan….

Public approval for the House version is dropping, even with Republican voters. It is predicted that the Senate version will be equally unpopular…

And while 16 percent of Republican voters opposed the bill in late April, about 30 percent of such voters now say they are against the bill, the Morning Consult/Politico survey found…

Just 35 percent of all voters now approve of the House bill, down from 42 percent at the end of April, according to that poll.

Another survey, also released Wednesday, found that majorities of voters oppose all the key provisions found in the House bill — even in congressional districts that voted strongly for Republicans in recent elections.


Opioid Deaths Skyrocketing …

Yesterday, the Washington Post report that opioid deaths in the U.S. have skyrocketed since 2005 according to a government report issued this month by the Healthcare Cost and Utilization Project.

The 2014 numbers, the latest available for every state and the District of Columbia, reflect a 64 percent increase for inpatient care and a 99 percent jump for emergency room treatment compared to figures from 2005. Their trajectory likely will keep climbing if the epidemic continues unabated.

The report, released by the Agency for Healthcare Research and Quality (AHRQ), puts Maryland at the very top of the national list for inpatient care. The state, already struggling with overdoses from heroin and prescription opioids, has seen the spread of the synthetic opioid fentanyl, which can be mixed with heroin or cocaine and is extraordinarily powerful. Gov. Larry Hogan (R) this year declared a state of emergency in response to the crisis.

The roots of the problem of opioid addiction are as old as history, but, the recent spike in opioid addiction and overdoses are attributed to two main factors, pain becoming a vital sign that a doctor looks at during an examination (remember the introduction of the smiley face posters for pain) and an extended release version of oxycodone released in 1996.

Fifteen years ago, a report by the Joint Commission on Accreditation of Healthcare Organizations, a nationally recognized medical society which accredits hospitals, stressed that pain was vastly undertreated in the United States. The report recommended that physicians routinely assess pain at every patient visit. It also suggested that opioids could be effectively and more broadly used without fear of addiction. This latter assumption was entirely mistaken, as we now understand. The report was part of a trend in medicine through the 1980s and 1990s toward treating pain more proactively.

The report was heavily publicized, and today it is widely acknowledged that it led to massive – and sometimes inappropriate – increases in the use of prescription opioid drugs to treat pain.

With more opioids being prescribed by well-meaning doctors, some were diverted from the legal supply chain – through theft from medicine cabinets or trade on the black market – to the street for illicit use. As more opioids leaked out, more people started to experiment with them for recreational purposes…

The second major factor was the introduction of an extended release formulation of the potent opioid oxycodone in the 1996. You may know this drug by its brand name, OxyContin. In fact, you might have been prescribed it after having surgery.

The drug was designed to provide 12-24 hours of pain relief, as opposed to just four hours or so for an immediate release formulation. It meant that patients in pain could just take one or two pills a day rather than having to remember to take an immediate release drug every four hours or so. This also meant that OxyContin tablets contained a large amount of oxycodone – far more than would be found in several individual immediate release tablets.

And within 48 hours of OxyContin’s release on the market, drug users realized that crushing the tablet could easily breach the extended-release formulation, making the pure drug available in large quantities, free from harmful additives such as acetaminophen, which most recreational and chronic abusers find irritating, particularly if they inject it intravenously. This made it an attractive option for those who wanted to snort or inject their drugs. Surprisingly, neither the manufacturer nor the Food and Drug Administration foresaw this possibility.

When one looks at the states that have the highest death rates for opioids, one can easily correlate this to the high number of prescriptions per 100 people. West Virginia,  Ohio, and Kentucky have a rate of 96 to 143 prescriptions written to people. New Hampshire has a rate 72 to 81 prescriptions per 100 people. These numbers just astonished me. But, the sources of people that abuse these drugs vary widely.

Most people who abuse prescription opioids get them for free from a friend or relative. However, those who are at highest risk of overdose (using prescription opioids nonmedically 200 or more days a year) get them in ways that are different from those who use them less frequently. These people get opioids using their own prescriptions (27 percent), from friends or relatives for free (26 percent), buying from friends or relatives (23 percent), or buying from a drug dealer (15 percent). Those at highest risk of overdose are about four times more likely than the average user to buy the drugs from a dealer or other stranger.

What will the Trump administration do about the opioid crisis? Well, not much that will be productive.

The White House is calling for a 95 percent funding cut for the Office of National Drug Control Policy, the agency leading the charge against the country’s opioid epidemic, according to sources knowledgeable about the White House’s draft budget for the coming fiscal year. ONDCP is responsible for coordinating drug prevention programs across federal agencies and was slated to fund President Donald Trump’s much-lauded opioid commission.

The budget would slash ONDCP’s $380 million budget to $24 million. It would eliminate the High Intensity Drug Trafficking Areas program, which coordinates local, state, and national efforts to reduce drug trafficking and has a $250 million annual budget. It would also cut the Drug-Free Communities Support Program, which funds community-based youth substance abuse prevention programs. The budget calls both programs “duplicative of other Federal programs.” The budget is a “passback” draft: it was cleared by the White House budget office last week, but will still need to be approved by Congress.

On the campaign trail, Trump promised to “spend the money” to address the opioid epidemic, but his proposed budgets and policies thus far would drastically cut federal funding to tackle the issue.




Why the US does not have universal health care, while many other countries do

File 20170511 32613 edj2t
House Speaker Paul Ryan walking into the Capitol on May 4, when the House voted narrowly to accept a bill he shepherded to replace Obamacare.
Andrew Harnik/AP

Timothy Callaghan, Texas A&M University

The lead-up to the House passage of the American Health Care Act (AHCA) on May 4, which passed by a narrow majority after a failed first attempt, provided a glimpse into just how difficult it is to gain consensus on health care coverage. The Conversation

In the aftermath of the House vote, many people have asked: Why are politicians struggling to find consensus on the AHCA instead of pursuing universal coverage? After all, most advanced industrialized countries have universal health care.

As a health policy and politics scholar, I have some ideas. Research from political science and health services points to three explanations.

No. 1: American culture is unique

One key reason is the unique political culture in America. As a nation that began on the back of immigrants with an entrepreneurial spirit and without a feudal system to ingrain a rigid social structure, Americans are more likely to be individualistic.

In other words, Americans, and conservatives in particular, have a strong belief in classical liberalism and the idea that the government should play a limited role in society. Given that universal coverage inherently clashes with this belief in individualism and limited government, it is perhaps not surprising that it has never been enacted in America even as it has been enacted elsewhere.

Public opinion certainly supports this idea. Survey research conducted by the International Social Survey Program has found that a lower percentage of Americans believe health care for the sick is a government responsibility than individuals in other advanced countries like Canada, the U.K., Germany or Sweden.

No. 2: Interest groups don’t want it

Even as American political culture helps to explain the health care debate in America, culture is far from the only reason America lacks universal coverage. Another factor that has limited debate about national health insurance is the role of interest groups in influencing the political process. The legislative battle over the content of the ACA, for example, generated US$1.2 billion in lobbying in 2009 alone.

The insurance industry was a key player in this process, spending over $100 million to help shape the ACA and keep private insurers, as opposed to the government, as the key cog in American health care.

While recent reports suggest strong opposition from interest groups to the AHCA, it is worth noting that even when confronted with a bill that many organized interests view as bad policy, universal health care has not been brought up as an alternative.

No. 3: Entitlement programs are hard in general to enact

A third reason America lacks universal health coverage and that House Republicans struggled to pass their plan even in a very conservative House chamber is that America’s political institutions make it difficult for massive entitlement programs to be enacted. As policy experts have pointed out in studies of the U.S. health system, the country doesn’t “have a comprehensive national health insurance system because American political institutions are structurally biased against this kind of comprehensive reform.”

The political system is prone to inertia, and any attempt at comprehensive reform must pass through the obstacle course of congressional committees, budget estimates, conference committees, amendments and a potential veto while opponents of reform publicly bash the bill.

Bottom line: Universal coverage unlikely to happen

Ultimately, the United States remains one of the only advanced industrialized nations without a comprehensive national health insurance system and with little prospect for one developing under President Trump or even subsequent presidents because of the many ways America is exceptional.

Its culture is unusually individualistic, favoring personal over government responsibility; lobbyists are particularly active, spending billions to ensure that private insurers maintain their status in the health system; and our institutions are designed in a manner that limits major social policy changes from happening.

As long as the reasons above remain, there is little reason to expect universal coverage in America anytime soon.

Editor’s note: this is an updated version of an article that originally ran on October 25, 2016.

Timothy Callaghan, Assistant Professor, Texas A&M University Health Science Center, Texas A&M University

This article was originally published on The Conversation. Read the original article.

Your teeth are connected to your body

Which is something insurance companies are reluctant to acknowledge.

As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter.

Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left.

1 in 5

Americans older than 65 do not have a single real tooth left.

Over two days at the civic center, volunteer dentists would pull 795 teeth. A remarkable number of patients held steady jobs — a forklift operator, a librarian, a postal worker — but said they had no dental insurance and not enough cash to pay for a dentist.

Matello had both problems, adding to her frustration about being cut off from a world that many wealthier Americans take for granted.

“The country is way too divided between well-off people and people struggling for everything — even to see the dentist,” she said. “And the worst part is, I don’t see a bridge to cross over to be one of those rich people.”

The last person you’d expect to die in childbirth

NICU 1960

Many years ago, I used to be a childbirth educator, and apprenticed as a lay midwife. I attended a couple of dozen births, and delivered one all by myself.

After all these years, this story made me cry. Preeclampsia is not a bolt from the blue. We’ve known for the past century it’s related to inadequate blood volume and nutrition (back when I trained, the research of Dr. Tom Brewer in Chapel Hill showed it to be the result of calorie, salt, and protein deficiency). Some research indicates strenuous exercise as a factor.NICU 1960

And yet, doctors persist in saying it can’t be predicted. As soon as I read this woman’s symptoms, I knew right away what it was. Why didn’t her doctors?

ProPublica Share on Facebook Share on Twitter Comment Donate Bryan Anselm for ProPublica The Last Person You’d Expect to Die in Childbirth The U.S. has the worst rate of maternal deaths in the developed world, and 60 percent are preventable. The death of Lauren Bloomstein, a neonatal nurse, in the hospital where she worked illustrates a… Continue Reading →

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