What Effect Will the Financial Crisis have on LTC?

The global financial system believes that we are entering a significant recession, even with the bail-out of the banking system.  I was wondering what impact this might have on long term care in the US. These are a few of the ideas I had. Leave comments if you have others:

  • Money for private pay will be reduced, putting more pressure on Medicaid
  • Rebuilding nursing homes will be far more difficult, because getting loans to do it or using bonds will be far more difficult
  • The already tenuous nursing home financial model will be put under additional pressure, as credit will be harder to find
  • Michigan's already broken state budget will get worse as the auto industry is put on life-support
  • Universal health care, though more necessary than ever, will likely take second place to supporting the financial system
What other ideas do you have? Or what do you think of these?

Governor cuts funding for long term care ombudsman program

from Los Angeles Business:

In a little-publicized line-item veto last month, Gov. Arnold Schwarzenegger eliminated state funding for California’s long-term care ombudsman program.

The $3.8 million cut represents half the funding for ombudsman services. The program investigates elder abuse and other complaints on behalf of 250,000 residents of California’s 1,300 nursing homes and more than 8,000 assisted living facilities.

“We are in a very difficult financial environment, as evidenced this week,” said Sarah Ludeman, spokeswoman for the California Department of Aging, which administers the program. “Each area will try to do the best they can with the money left.”

The cut came days after the federal government issued a report condemning conditions in nursing homes.


Barrett, Walker: Don't depend on Washington for long-term care solutions

from McKnight's: 


Two high-profile private sector leaders entreated long-term care providers Tuesday to take control technological innovation and care delivery by the horns and not wait for the federal government to act.

“You hold the power in your hands. It's not in Washington's hands,” said Craig Barrett, chairman of the board of Intel Corp.

He along with David Walker, former comptroller general of the United States, were the keynote speakers during the general session Tuesday at the annual conference of the American Association of Homes and Services for the Aging in Philadelphia.

Barrett stressed that the Center for Aging Services Technology (CAST), the technology arm of AAHSA, develop a standard for electronic health records because the government has been slow to act on it.



To see a McKnight's interview with Walker, go to the home page of www.mcknights.com.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

AAHSA's financing plan has proponents, Minnix says

from McKnight's: 


The American Association of Homes and Services for the Aging's long-term care financing plan has gained traction with lawmakers on both sides of the aisle, as well as consumer groups, said Larry Minnix, president and CEO of the association.

“It's not a red state plan or a blue state plan,” said Minnix during a press conference at AAHSA's annual meeting and exposition this week in Philadelphia. The conference runs through Wednesday.

The plan calls for a national insurance trust which would provide a daily cash benefit for people needing assistance. Minnix noted that AAHSA's plan differs significantly from the plan proposed by the American Health Care Association. The AHCA plan would ask people to purchase a long-term care policy or place funds into long-term care savings vehicles.

“It does some good things, but it doesn't solve the problem,” Minnix said. 

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

Law Equalizes Coverage For Mental, Physical Care

from Washington Post: 



An estimated 113 million Americans, including hundreds of thousands in the Washington region, will receive better insurance coverage for their mental health and substance abuse problems because of landmark legislation that for the first time requires mental and physical illnesses to be treated equally.
The law is a culmination of a decade of lobbying and negotiating among advocates for the mentally ill, the insurance industry, the business community -- including the U.S. Chamber of Commerce -- and doctors' groups. The change, which was included in the economic rescue package signed by President Bush last week, will take effect Jan. 1, 2010, for most plans. Businesses with 50 or fewer employees would be exempt.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

http://www.huffingtonpost.com/stuart-shapiro/presidential-candidates-l_b_133373.html

from Huffington Post: 



The good news is that Americans are living longer than they have previously.
The bad news is that our nation's financial and health-care systems are woefully unprepared for them.

What's worse, neither presidential candidate seems to be giving it much thought.
U.S. Sens. John McCain and Barack Obama may spar over Social Security and tinker around the edges of entitlement programs Americans know best, but neither has a serious plan to stabilize our retirement foundation to provide a true safety net for the elderly.


Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

Person-Directed Dementia Care Assessment Tool: A guide for creating quality of life and successfully refocusing behavior

from Info Long-Term Care: 


This tool was developed by the State of Wisconsin, Department of Health and Family Services, Division of Disability and Elder Services to be used as a guide for identifying the elements involved in implementing a person-directed dementia care.

The nine sections of the tool examine specific areas of focus vital in providing person centred care, emphasizing culture change elements. The goal is to provide as much planning to meet an individual's social and emotional needs.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

Great Comment lost in vacation

Greg Pawelski left a great comment on a post on the impact of private equity firms buying nursing homes. But, I was on vacation and didn't get around to looking at comments til today. So here is the Comment in it's entirety:

Greg Pawelski has left a new comment on your post "Private equity firms do not affect nursing home qu...": 

Staffing Cuts and Mounting Patient Care Problems at Manor Care's Pennsylvnia Facilities under Carlyle's Ownership 

A new analysis of federal government data reveals staffing cuts and a surge in violations at ManorCare’s Pennsylvania nursing homes while under Carlyle’s ownership. Average nurse and CNA staffing has actually decreased to just 3.29 hours per resident per day (HPPD) at the 20 Pennsylvania Manor Care nursing homes that have undergone annual surveys since Carlyle acquired the company on December 21, 2007. (1) Nurse staffing was cut by 21.4% to just 3.05 HPPD at Manor Care Health Services – Lansdale, a 170 bed facility in Montgomeryville. (2) In addition, none of the 20 facilities provided the 4.07 hours of care identified by experts in a 2001 study as the threshold below which quality of care is compromised. (3) This staffing data may help to explain a surge in violations of federal health and fire safety standards at these facilities, which increased 31% overall to 202 violations in their post-buyout surveys. (4) 

Government survey records describe the tragic stories behind these violations: 

ManorCare Health Services - York South was cited in January 2008 and again in May for two separate incidents involving a failure to timely notify a physician of a resident’s change in condition. The residents involved in both incidents died. In January, a resident with a history of fainting and at a known risk for falls fell and died several days later as a result of blunt force head trauma sustained in the fall. Incomplete information was faxed to a physician’s closed office, but a physician was not actually called for more than 17 hours after the fall occurred, during which time the resident exhibited symptoms of increased confusion and vomiting. (5) In May, the facility again failed to timely notify a physician after a resident, whose medication carried a known risk of side effects including heart attacks, complained of head and chest pain and had elevated blood pressure. The resident went into fatal cardiac arrest late that night. (6) 

ManorCare Health Services at Mercy Fitzgerald was cited by government inspectors for failing to provide timely assistance to a resident who had amputations of both legs, whose repeated requests for assistance in using the bathroom went unanswered over the course of half an hour. (7) 

Donahoe Manor was cited for failure to follow state law and its own policies requiring an FBI criminal background check for an employee who had been hired more than 9 months earlier, and for hiring a dietary aide who worked on the tray line and delivering carts before his tuberculosis skin test was completed. (8) 

(1) This average is weighted to reflect different homes census level. The staffing data is based on information from “About the Nursing Home–Inspection Results,” Centers for Medicare and Medicaid Services Nursing Home Compare data, downloaded 7/22/2008 and 11/09/2007. Under federal law, nursing homes must be inspected every nine to 15 months. 

(2) Ibid. 

(3) Ibid. 

(4) Ibid. 

(5) MANORCARE HEALTH SERVICES-YORK SOUTH, Incident investigation and a State monitoring visit, 01/09/2008, F-0309. 

(6) MANORCARE HEALTH SERVICES-YORK SOUTH, Medicare/Medicaid Recertification, 

State Licensure, Civil Rights Compliance and Incident investigation survey, 05/22/2008, F-0309. 

(7) MANORCARE HEALTH SERVICES AT MERCY FITZGERALD, M edicare/Medicaid Recertification, State Licensure and Civil Rights Compliance Survey, 01/08/2008, F-0309. 

(8) DONAHOE MANOR, Medicare/Medicaid Recertification Survey and State Licensure Survey, 01/07/08, F-0226, F-0630. 
Posted by Greg Pawelski to LTC Reform at October 6, 2008 9:18 PM

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

The depth of self-serving arrogance

A recent study of minimally conscious people, using scans to compare the response of normal volunteers and people recovering from PVA,  showed that they feel pain.  Why does such a study merit the wide reach of Medical News Today?

Because, believe it or not, there are actually medical professionals who believe that it is alright to cause untreated pain in patients as long as they have a rhetorical excuse to do so.  In this case, the excuse is that since minimally conscious patients don't report pain in terms that doctors can understand, they must not feel any. Such an assertion is almost academic in its disconnection from the real world.  Unfortunately, medicine is not so disconnected. Such self-serving beliefs cause real suffering for real people.

Vulnerable people can always be treated as non-persons by medicine. But, there is no law of nature requiring medicine to do so. It is truly a shame that we must use all of our technology to force medicine to behave decently.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

Duh! of the Week

from Medical News today: 


Patients Who Recover From Coma But Cannot Communicate Feel Pain



Do patients who survive a severe brain injury but fail to recover speech or non-verbal communication perceive pain ? After their remarkable publication where they showed that a patient in a vegetative state in reality was conscious, scientists at the University of Liège (ULg) were able to tackle the very difficult issue of pain perception in coma survivors.

The Coma Science Group of the Cyclotron Research Centre and Neurology Department of the ULg used PET scanning to measure minimally conscious and vegetative patients' brain activation in response to noxious stimulation.

After comparing results obtained in the different patient groups with those in healthy volunteers who could communicate it felt painful they concluded that minimally conscious patients must feel pain despite being unable to tell their environment. Hence, these patients should receive pain-killers, the authors concluded.

This study has major ethical and therapeutical consequences also with regard to end-of-life decisions in these challenging but vulnerable patient populations



See my next post for commentary

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/