Health and Disability

This will only get worse if Medicaid is cut....

https://goo.gl/ank5Eo

In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.

The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.

But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Ms. Fisher slipped from her wheelchair, fracturing her hip the final time.

The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.

While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to an analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.

These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.

Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Ms. Fisher.

About 60 million Americans live in rural areas. And almost every health statistic shows they’re falling behind their fellow Americans who live in urban areas. Rural residents are less likely to have health insurance coverage through a job, have lower incomes, and have higher rates of death from heart disease and stroke.

However, there’s not only a health gap widening between urban and rural areas. There’s also a growing gap between the way systems of health work in different areas of the country.

As reported in a recent study commissioned by the Episcopal Health Foundation (EHF), seventeen rural hospitals in Texas have closed since 2010. After EHF released the report this May, two more rural hospitals—East Texas Medical Center Trinity in Trinity, Texas, and Timberlands Healthcare in Crockett, Texas—announced their closures. At EHF, we have followed with great interest the changes and challenges in rural health care, and particularly the impact on rural communities when their hospitals close.

We believe the financial pressures experienced by rural hospitals are likely to continue. As a philanthropy serving both rural and urban communities, EHF wanted to understand in this study how rural communities threatened by hospital closures could ensure that a reliable system of health care services would be accessible to residents, should their hospital close.

We knew this was a complicated problem that required critical analysis to develop practical solutions. We were fortunate to partner with a great team at the Rural and Community Health Institute (RCHI) at Texas A&M University. The team is led by Nancy Dickey, a visionary rural health leader, researcher, and former American Medical Association president.

Purpose: To provide greater access to care for behavioral health services.

The entire policy proposal is below the header I posted.

Employer-based insurance will also be degraded by the current House and Senate health bills...

https://goo.gl/f1crLM

As Senate Republican leaders continue to craft their bill to repeal and replace the Affordable Care Act (ACA), most attention has been focused on the number of individuals who would lose coverage if the legislation is enacted. To be sure, the ACA coverage expansions—through Medicaid and subsidized Marketplace plans—have been a lifeline for millions of people, particularly those who are low income, and have reduced the number of individuals without coverage to record lows. But the legislation that passed the House and the bill now under consideration in the Senate could also affect the more than 150 million people with employer-sponsored insurance (ESI) who gained federally guaranteed protections against catastrophic costs.

Earlier this year, I wrote about ACA reforms that apply to employer-based plans. At the time, we didn’t know yet what GOP repeal plans would retain of the ACA and what would be lost. Now, with the bills under discussion, we know more about what’s at risk for those with job-based plans.

What Protections Can People With ESI Hope To Retain?

Both the House-passed American Health Care Act (AHCA) and the Senate’s Better Care Reconciliation Act (BCRA) leave untouched the requirement that job-based plans cover recommended preventive services without cost-sharing, the prohibition on excluding coverage for pre-existing conditions, and the right to appeal your plan’s denial of care to an independent expert reviewer. The bills also retain the requirement that plans that cover dependents must make that coverage available until they turn 26. However, this latter protection could become illusory. Both bills repeal the requirement that large employers offer coverage to employees and their dependents. Thus, the right to keep a child on a parent’s plan until they turn 26 can only be exercised by those with employers willing to continue offering dependent coverage.

What Are The Risks For People With ESI Who Have Pre-Existing Conditions?

Now let’s look at what might be lost. The biggest risks are for employees with pre-existing and chronic conditions because they can no longer count on comprehensive benefits and the ACA’s protections against catastrophic costs that are tied to those benefits. Both the House and Senate bills allow states to waive the essential health benefits (EHB), the ACA requirement that individual and small employer plans cover 10 categories of services, including services often excluded from coverage prior to the ACA. For people who work for small businesses (fewer than 50 workers), a waiver from EHB would mean skimpier coverage that may exclude key services such as prescription drugs, maternity care, or mental health treatment.

Despite his best efforts, Senate Majority Leader McConnell couldn't coax a ‘yes’ vote out of 50 of his 52-member caucus before the July Fourth recess. The path forward for McConnell and the Senate Republicans seems to revolve around trying to move in two directions at once – more money for the more centrist party members coupled with more insurance deregulation for the far-right -- while continuing to mislead the public about the true content of the bill.

Here's a closer look at why the Senate bill stalled and what steps are being taken to revive it, along with some notable bits and pieces from the recent debate.

Why McConnell couldn't get to ‘yes’ before the Fourth

Despite FDA warnings regarding the risk for adverse effects from administering long-acting opioids to patients who had not developed opioid tolerance through prior usage, the initiation of potent long-acting fentanyl patches (Duragesic, Janssen) without first receiving an opioid analgesic persists for these residents (J Am Geriatr Soc 2016;64:1772-1778).

Of 12,278 long-stay Medicare-enrolled nursing home residents who were prescribed long-acting opioids within 30 days of admission in 2011, 9.4% had not received an opioid analgesic in the previous 60 days, according to the study.

Michigan is doing reasonably well in regard to rural hospital closings at least until Medicaid Expansion disappears...

https://goo.gl/uRhKJx

Ultimately, the hospital closed that Friday, leaving the rural town without a hospital for miles. Raju, who had been the hospital's chief of staff, is now the only doctor left in the town a two-hour drive south of Atlanta.

"These hospitals are hanging on by their fingernails," said Maggie Elehwany, vice president of government affairs for the National Rural Health Association, a nonprofit health research and advocacy group. "If you leave this legislation as is, it's a death sentence for individuals in rural America."

The connection between slowed walking speed and declining mental acuity appears to arise in the right hippocampus, a finger-shaped region buried deep in the brain at ear-level, according to a 14-year study conducted by scientists at the University of Pittsburgh Graduate School of Public Health.

The finding, published in Neurology, the medical journal of the American Academy of Neurology, indicates that older patients may benefit if their doctors regularly measure their walking speed and watch for changes over time, which could be early signs of cognitive decline and warrant referral to a specialist for diagnostic testing.

"Prevention and early treatment may hold the key to reducing the global burden of dementia, but the current screening approaches are too invasive and costly to be widely used," said lead author Andrea Rosso, Ph.D., M.P.H., assistant professor in Pitt Public Health's Department of Epidemiology. "Our study required only a stopwatch, tape and an 18-foot-long hallway, along with about five minutes of time once every year or so."

Rosso and her colleagues assessed 175 older adults ages 70 to 79 when they enrolled in the Health, Aging and Body Composition (Health ABC) study in Pittsburgh or Memphis, Tennessee. At the beginning of the study, the participants were all in good mental health and had normal brain scans. Multiple times over 14 years, the participants walked an 18-foot stretch of hallway at what they deemed a normal walking pace while a research assistant timed them. At the conclusion of the study, the participants were tested again for their mental acuity and received brain scans.

As previous studies have shown, slowing in the participants' gait, or walking speed, was associated with cognitive impairment. However, Rosso's research determined that participants with a slowing gait and cognitive decline also experienced shrinkage of their right hippocampus, an area of the brain important to both memory and spatial orientation. It was the only area of the brain where the researchers found a shrinking volume to be related to both gait slowing and cognitive impairment.

Rosso's study also found gait slowing over an extended period of time to be a stronger predictor of cognitive decline than simply slowing at a single time point, which is what other, similar research evaluated. All the participants slowed over time, but those who slowed by 0.1 seconds more per year than their peers were 47 percent more likely to develop cognitive impairment. The finding held even when the researchers took into account slowing due to muscle weakness, knee pain and diseases, including diabetes, heart disease and hypertension.

What does a resident of Calton in Glasgow have in common with the average American?

Neither is very healthy.

All over the world health, as measured by life expectancy, is improving. But, not improving as much in Glasgow, especially not in Calton, a poorer part of the city; nor among middle-aged Americans, especially not among people of low education.

When, in 2015, Angus Deaton won the Nobel Prize for Economic Science it generated the expected press interest. When, a few weeks later, Anne Case and Angus Deaton, both Princeton economists, published a paper on trends in mortality in the US it generated ten times the press interest. What the paper showed was truly shocking. Case and Deaton examined trends in mortality rates in men and women, aged 45 to 54, from 1990 to 2012. Rates were coming down in France, Germany, UK, Canada, Australia and Sweden; as they were in US Hispanics. But in non-Hispanic whites, rates were rising. The fewer the years spent in education the steeper the rise. The social gradient in mortality was getting steeper.

Members of the Faculty of Biology and A.N. Belozersky Institute of Physico-Chemical Biology, a unit of the Lomonosov Moscow State University, have tested on a mouse model a mitochondria-targeted antioxidant, helping to treat diabetic wounds. The scientists have presented the results in the paper accepted for publication in the Oxidative Medicine and Cellular Longevity journal.