Tag: William J. Beerman

As C. Diff Month Draws to a close

A lonely grandmother gazes at the photo of loved ones.

I’m William Beerman, author of the book, “Mary Regina’s Nursing Home.” In recognition of C. Diff Awareness Month (November), I am sharing the following from my personal life experience.   

The disease C. Diff (Clostridioides difficile) is the most common healthcare-associated disease. It generates a half million infections a year and elderly persons in nursing homes are especially at risk. 

I manage a Facebook page called Nursing Home Monitor, so of course, I’ve known for months that relatives of nursing home patients were banned from visiting their loved ones because of the COVID-19 virus.

But I didn’t expect to see the heartbreak of the nursing home personal visitation ban dramatized right before my eyes.

As I was delivering election information to a nursing home in Las Cruces, NM on October 27, 2020, a patient on a gourney and her daughter were checking in at the front desk. When they were finished, an attendant wheeled the patient away, and I heard the daughter say quietly, “I am so sad I cannot go with my mother.”  The check-in host answered, “Yes, it is very sad.”

A transfer from a hospital to a nursing home is stressful enough these days. But it can be worse with the serious complication of C. Diff, an antibiotic-resistant bacteria that causes uncontrollable diarrhea.

The admission of the patient October 27 reminded me of the day I admitted my own mother to a nursing home in Pittsburgh in 2011 after she had a short stay in a hospital for repair of a broken hip. The nursing home turned out to be a bad one. But we could not get my mother transferred out because she came down with C. Diff.

C. Diff is contagious and requires the patient to have an isolation room. Medicare paid only a few dollars more for an isolation room than it paid for a semiprivate room. So any nursing home that accepted my mother would lose a lot of money because it would have to devote a room for two to just one patient. Nursing homes that we called while trying to transfer my mother said they had no isolation rooms available.

C. Diff played a big part in the death of my mother, who had been living independently before she broke her hip. She was an excellent candidate for rehab. But she died 30 days after being admitted to the nursing home, with C. Diff and a half dozen other afflictions.

The nursing home told me my mother had probably gotten C. Diff because the hospital had given her a heavy dose of antibiotics just before releasing her. The theory was that the dose wiped out benign bacteria and cleared the way for the antibiotic-resistant C. Diff to run rampant through my mother’s bowels without competition.

You can read about a lot of ways to fight C. Diff at the Peggy Lillis Foundation website https://cdiff.org, or  https://peggyfoundation.org/ , or at the C. Diff Foundation website: https://cdifffoundation.org/  They are trying to raise awareness of C. Diff, and the fact that antibiotic use is the most common risk factor for C. Diff. The Peggy Lillis Website cdiff.org has a petition you can sign.

But one way to fight C. Diff that appeals to me is for the hospital patients being discharged to nursing homes to discuss the issue of antibiotics and C. Diff with the hospital staff.

This year the government Centers for Medicare and Medicaid Services — CMS — issued a rule that requires hospitals to provide discharge planning consultation for patients being released to nursing homes and other settings. You can discuss use of antibiotics with the hospital staff and select a nursing home that is appropriate for you. You are less likely to end up in a poorly rated one by accident.

Check out the guidance about selecting an appropriate nursing home and making your antibiotic treatment preferences known through the new CMS discharge planning rule at CMS’ Discharge Planning Rule Supports Interoperability and Patient Preferences | CMS.

So, You Favor Single-Payer Health Care? How Are Those NURSING HOMES Working Out?

Nursing Home Scene

By William J. Beerman, Sr.

Over the decades, bad nursing homes have hemorrhaged a ceaseless stream of scandals and lawsuits alleging neglect and serious harm to patients.

Yet the world of nursing homes comes close to looking like single-payer health care. The American Health Care Association (AHCA) reports that 71 percent of nursing home revenues come from the government: 57 percent from Medicaid and 14 percent from Medicare. Some nursing homes get virtually ALL of their revenue from Medicaid.

So, in light of our experience with nursing homes, should single-payer health care advocates be more careful about what they ask for?

AHCA is a non-profit federation of state health organizations, together representing more than 13,500 non-profit and for-profit nursing facilities, assisted living facilities, and other facilities that care for approximately 1 million elderly and disabled individuals each day.

AHCA says the payments the nursing home industry gets from Medicaid fall short of what the nursing homes need to fully comply with regulations by $25 per Medicaid-patient-day, or collectively by $7 billion a year.

The nursing home operators say they are plagued by excessive and inappropriate regulations and costly questionable lawsuits that consume money that could be better spent at the bedside.

Hundreds of thousands of people have filed formal complaints about nursing homes, while in recent years, as the number of complaints rose, the number of government enforcement actions declined.

There are many good nursing homes, and many poor ones. Medicare.gov rates nursing homes on a scale, with one star equating to “much below average” and five stars meaning “much above average.” The rating for “average” is three stars. For example, a search I did in 2016 for nursing facilities in Pennsylvania belonging to the Golden Living chain, which is the subject of a contested Pennsylvania Attorney General consumer-protection lawsuit, turned up 36 Golden Living nursing homes. Two had five stars, seven had four, 10 had three, seven had two, and 10 had one star. So, 47 percent were below average (one or two stars). Some below-average nursing homes stay open for years and continue to receive government funds.

Critics say nursing homes can game the Five-Star rating system and that the system does not consider the opinions of the residents. Nursing home workers told investigators in multiple states that managers knew when state inspectors were coming. A Florida state nursing home regulator, Bertha Blanco, was sentenced in December 2017 to prison for selling confidential inspection schedules and copies of patient complaints to nursing home operators for $100,000 in bribes.

The overseer of nursing homes is the would-be single payer: the government. The inspectors generally are state health departments, which in turn follow regulations issued by the Centers for Medicare & Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS).

On the west coast, the California Advocates for Nursing Home Reform released a white paper in December that the organization says summarizes major problems in long-term care in California. It begins: “The quality of nursing home care in California has never been worse.”

On the east coast, New York State Senator Rob Ortt (R-North Tonawanda) announced in a televised news conference December 27 that he was introducing new nursing home regulatory bills because: “Since I have been in office, the quality of care in the nursing homes across our state has been a persistent issue and it has continually gone unaddressed.”

U.S. Senator Bob Casey (D-PA) has been criticizing government oversight of nursing homes for decades. When he was Pennsylvania’s auditor general in 1998, he issued a scathing audit report about the state health department’s oversight of nursing homes. It was entitled “Residents in Jeopardy.” In a 1998 news release Casey said the Pennsylvania Department of Health had “failed miserably” in its oversight of nursing home care. Casey followed up with another audit report entitled “Residents Still in Jeopardy.”

More recently, current Pennsylvania Auditor General Eugene DePasquale issued a report critical of the health department’s oversight of nursing homes in 2016, and ongoing state attorney general lawsuits in Pennsylvania and New Mexico describe horrendous conditions that AG investigators found in nursing homes.

Last year, about 20 years after his “Still in Jeopardy” audit, Casey was among a group of 12 U.S. senators who sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma saying in essence that they were alarmed that proposed easing of nursing home regulations was putting nursing home residents “at greater risk.”

The senators cited a report by the HHS Office of Inspector General (OIG) from 2014 that found that, during a Medicare-covered stay, nearly a third of nursing home patients experienced an adverse event or an incident that led to temporary harm, with 59 percent of these events being considered preventable. “More alarming,” said the senators, “is that during the one-month period that OIG reviewed, Medicare incurred a cost of $208 million due to hospitalizations (of nursing home residents) alone and found that adverse events contributed to 1,538 deaths, most of which had not been anticipated.”

So, one must wonder, is the government system that oversees and largely funds our nursing homes ready to take over all of our health care?

William J. Beerman, Sr., is a retired former journalist whose mother’s nursing home experience motivated him to write Mary Regina’s Nursing Home, a book about nursing homes and government oversight of nursing homes (www.WBeerman.com). Besides his home page, William maintains a Facebook Page, Nursing Home Monitor.