Trump's At­tack on Se­niors

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Those who are clos­est to it know the truth: Hold­ing nurs­ing homes ac­count­able for their poor care and sub­stan­dard fa­cil­i­ties is a thing of the past. Trump is now mak­ing things even worse.

Many Amer­i­can nurs­ing homes are abysmal, and far more than a few are abu­sive and preda­tory crim­i­nal en­ter­prises.

Fed­eral records show that roughly 40% of all nurs­ing homes have been cited at least once for se­ri­ous vi­o­la­tions since 2013. Those vi­o­la­tions are not even ones that are com­pli­cated to ad­dress, with sim­ple mea­sures to avoid cross-in­fec­tion within such in­sti­tu­tions reg­u­larly be­ing ig­nored. Those in­clude steps such as wash­ing hands, keep­ing con­ta­gious pa­tients apart from oth­ers and sep­a­rat­ing sick nurses, aides and other med­i­cal sup­port staff so they can­not in­fect the pa­tients. Such mis­takes are not mi­nor is­sues. Ac­cord­ing to an in­ves­ti­ga­tion by Kaiser Health News (KHN), in­fec­tions that hap­pen after pa­tients en­ter a nurs­ing home – rather than be­ing the rea­son why the pa­tients ar­rived at the nurs­ing homes in the first place – cre­ate 25% of the med­i­cal in­juries Medi­care ben­e­fi­cia­ries ex­pe­ri­ence there. A sep­a­rate gov­ern­ment cal­cu­la­tion sug­gests that such in­juries may be con­tribut­ing to as many as 380,000 deaths a year.

There are also is­sues re­gard­ing ne­glect and mis­treat­ment of pa­tients, with re­ports in some nurs­ing homes of pa­tients not even re­ceiv­ing ba­sic care, such as help­ing them bathe (when needed), emp­ty­ing bed­pans on a reg­u­lar ba­sis and en­sur­ing proper fol­low-up care on all is­sues.

De­spite this, both the re­port­ing of health care vi­o­la­tions re­lated to these and dis­ci­plinary ac­tion fol­low-up after such re­ports are quickly be­ing scaled back. Un­der new

rules pro­vided by Cen­ters for Medi­care & Med­i­caid Ser­vices (CMS), reg­u­la­tors are strongly be­ing urged to avoid as­sess­ing nurs­ing home fines if the vi­o­la­tions, how­ever se­ri­ous, are deemed to be just iso­lated mis­takes. For more se­ri­ous mis­takes that had ex­isted for some time be­fore in­spec­tors found them, in­stead of fol­low­ing the past prac­tice of as­sess­ing back­dated daily fines to when they were recorded, in­spec­tors are be­ing asked to just as­sign one-time fines for an en­tire string of prob­lems.

This is all hap­pen­ing in an en­vi­ron­ment where an­tibi­otic-re­sis­tant germs like MRSA, the well-known acro­nym for me­thi­cillin-re­sis­tant Staphy­lo­coc­cus au­reus, have spread rapidly within such fa­cil­i­ties. CMS, how­ever, says that even in these sit­u­a­tions, fines for in­fec­tion con­trol are not im­por­tant.

Ex­cuses abound for why these prob­lems ex­ist. It is very clear that un­der­staffed sup­port within nurs­ing homes, some­thing that should be a citable of­fense in it­self, plus low wages, poor train­ing and over­worked staff all con­trib­ute. With­out proper su­per­vi­sion and after long hours, nurs­ing home staff can make the health con­di­tions for their pa­tients even worse in a sur­pris­ingly short amount of time. And this can also turn into a very dark and se­ri­ous sit­u­a­tion if noth­ing is done about the poor care im­me­di­ately after it has been flagged.

As one ex­am­ple, KHN had in­ves­ti­gated the spe­cific sit­u­a­tion with Ge­orgina Mor­ris, who was a pa­tient at the As­to­ria Nurs­ing & Re­ha­bil­i­ta­tion Cen­ter in Syl­mar, Calif., in Oc­to­ber 2015. While she was there, it ap­pears she con­tracted an in­fec­tion from a highly dan­ger­ous strain of Clostrid­ium dif­fi­cile, also known as C. diff. She de­vel­oped se­vere de­hy­dra­tion and was even­tu­ally sent to a hos­pi­tal, where she stayed for 10 days. The only prob­lem was that she was sent there not at the urg­ing of the cen­ter but in­stead at the re­quest of James Mor­ris, her son, who had watched in hor­ror how she was be­ing treated.

What he had ob­served at the cen­ter, by his own ac­counts, was that “work­ers were com­ing in and out with­out wash­ing their hands.” He asked for help to in­ves­ti­gate the fa­cil­ity.

Eigh­teen months later, state in­spec­tors fi­nally checked the cen­ter. It was dis­cov­ered that As­to­ria em­ploy­ees had not been prop­erly clean­ing their hands while treat­ing Ge­orgina Mor­ris. Un­for­tu­nately, be­cause that had been go­ing on for such a long pe­riod of time, ac­cord­ing to KHN, “they could not def­i­nitely de­ter­mine whether Ms. Mor­ris con­tracted the in­fec­tion there or be­fore she ar­rived.”

That nurs­ing home was even­tu­ally cited, for the sec­ond year in a row, for sub­stan­dard in­spec­tion con­trol with the po­ten­tial to harm res­i­dents. No fine was as­sessed, though, so the pain for the in­sti­tu­tion went away rapidly – even if not so for Ms. Mor­ris, who con­tin­ued to suf­fer af­ter­wards for some time.

Even after all that, along with the 6,500 nurs­ing homes be­ing cited an­nu­ally for nurs­ing home vi­o­la­tions and the many pa­tients who be­came sicker and in­curred higher Medi­care ex­penses in many cases as a re­sult, the in­dus­try has pushed back against a call for fur­ther re­form, mon­i­tor­ing, ci­ta­tions and penal­ties against them. In De­cem­ber 2016, Mark Parkin­son, Pres­i­dent of the Amer­i­can Health Care As­so­ci­a­tion, wrote Pres­i­dent-elect Don­ald Trump plead­ing for help, say­ing that “it is crit­i­cal we have re­lief.” The re­lief he was seek­ing was to have Medi­care’s health in­surance pro­gram penalty pro­to­cols changed and eased.

For the evil and stupid Trump ad­min­is­tra­tion, which when asked to choose be­tween the com­mon good and the en­rich­ment of big busi­ness fa­vors the lat­ter, the choice was clear. Those reg­u­la­tions were eased, and since then, fines – as well as re­port­ing re­quire­ments – have been cut back sub­stan­tially for nurs­ing home own­ers who have not taken proper care to keep their pa­tients safe and on the road to health.

The health care providers, on the other hand, are look­ing for­ward to a far more prof­itable fu­ture with­out the mod­est costs of pro­vid­ing safe and healthy con­di­tions for their clients.

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