Trump's Continuing War Against Seniors In Long Term Care Facilities

Last Wednesday we noted the latest group Trumpanzee's Regime in targeting: senior citizens in long term care facilities. The Regime is trying to take away the right of victims of nursing home abuse to sue the nursing facilities-- something they claim in bad for business... businesses that contribute a great deal of money to corrupt conservative officials. And they tried to minimize the seriousness of old people in nursing homes being abused and neglected-- as though it rarely happens. That's just another Trump World lie, as an A.P. report made clear Monday afternoon.

More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients apparently went unreported to police, says a government audit that faults Medicare for failing to enforce a federal law requiring immediate notification.

The Health and Human Services inspector general's office issued an "early alert" Monday on preliminary findings from a large sampling of cases in 33 states. The results were sufficiently alarming that investigators say corrective action is needed now.

"We hope that we can stop this from happening to anybody else," said Curtis Roy, an audit manager with the inspector general's office, which investigates fraud, waste and abuse in the health care system. The audit is part of a larger ongoing probe, and additional findings are expected.

With some 1.4 million people living in U.S. nursing homes, quality is an ongoing concern. Despite greater awareness, egregious incidents still occur.

In a statement, Medicare emphasized that nursing home safety is a high priority, but said it will await a complete report before announcing a response. That didn't impress Sen. Charles Grassley, R-Iowa, who said he will push for Medicare to take immediate action.

"A crime is a crime wherever it takes place," Grassley said in a statement. "It's unacceptable for more than one-fourth of potential crimes in nursing homes to apparently go unreported."

Of the unreported cases, about 4 out of 5 involved alleged or suspected rape or sexual abuse.

The inspector general urged Medicare to systematically scour computerized billing records for tell-tale signs of possible abuse of nursing home residents. Investigators used that approach to find the cases, matching hospital emergency room and nursing home records.

Auditors identified 134 cases in which emergency room records indicated possible sexual or physical abuse, or neglect. The incidents spanned a two-year period from 2015-2016.

Illinois had the largest number of incidents overall, with 17. It was followed by Michigan (13), Texas (9), and California (8).

In 38 of the total cases (28 percent), investigators could find no evidence in hospital records that the incident had been reported to local law enforcement, despite a federal law requiring prompt reporting by nursing homes, as well as similar state and local requirements.

The federal statute has been on the books more than five years, but investigators found that Medicare has not enforced its requirement to report incidents to police and other agencies, or risk fines of up to $300,000.

Nursing home personnel must immediately report incidents that involve a suspected crime, within a two-hour window if there's serious bodily injury. Otherwise, authorities must be notified within 24 hours.

Medicare "has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in (nursing homes) are identified and reported," the inspector general's report said. Medicare responded it has long required immediate reporting, but to state inspectors.

Even among the 96 cases that were ultimately reported to police departments, investigators were unable to tell if the federal requirement for "immediate" notification was followed.

In one case classified as "reported to law enforcement," an elderly woman with verbal and mobility limitations was taken to the emergency room after she was allegedly sexually assaulted by a male resident of the same nursing home. The report said two silver-dollar-sized bruises were noted on her right breast.

Nursing home staff had helped the woman bathe and change clothes after the incident. "These actions could have destroyed any evidence that may have been detected using the rape kit," said the report.

Nursing home employees did not immediately report the incident to police, although the federal reporting requirement was in effect. The nursing home "should have reported the incident to law enforcement within two hours of witnessing the incident," the report said.

Instead, the following day the nursing home contacted the woman's family, who called the police, triggering an investigation.

Citing a separate probe by state officials, the inspector general's report said the nursing home "contacted local law enforcement in an attempt to keep law enforcement from investigating the incident."

The state's own report found that the nursing home told police "we were required to report it but that we were doing our own internal investigation and did not need (police) to make a site visit...no one was interested in pressing charges." The police continued their investigation.

The state later cited the nursing home for failing to immediately notify the patient's doctor and family, as well as other violations of federal regulations. But state inspectors classified the incident as resulting in "minimum harm or potential for actual harm."

No other details were provided in the federal report. The inspector general's office reported all 134 cases to local police.

The number of nursing home residents is expected to grow in coming years as more people live into their 80s and 90s. Medicaid is the main payer for long-term care, while Medicare covers doctors' services and hospital care for elderly people and the disabled.

In a statement, the nursing home industry trade group said its members know they must immediately report alleged abuse. The American Health Care Association said it will work with the government to ensure safety.

-photo by Nirmal Gosh... Maryland

Dr. Kathie Allen, the progressive Democrat running for the open congressional seat in Utah's 4th district, offered to add an important perspective... "that many nursing home patients are unable to speak for themselves, so it is up to providers and family members to advocate for them. Sexual abuse of nursing home patients is a real and present danger and is under-reported. To force a patient to opt for arbitration instead of legal resolution of possible malpractice is to ignore the fact that many people being admitted to nursing homes are not fully lucid due to recent surgery, drugs, and innervated status. They should not be induced to compromise their rights while their mental state is suboptimal. This whole thing is a disgrace."





UPDATE: Here's An Example Of Why Dotty Nygard Will Replace Jeff Denham In Congress

Although the DCCC recruited some wealthy San Franciscan to run in CA-10 (Modesto, Tracy, Manteca, Turlock and Riverbank) Dotty Nygard, a nurse and former local elected official, is the progressive in the primary race. She told us that "It's horrifying that there are people in our communities who have the audacity to abuse the elderly. As a healthcare provider, I am mandated to report any suspicion of neglect or abuse immediately. Unfortunately, there have been several situations involving elder abuse where I have been forced to report individuals who have the nerve to harm seniors who were in an extremely vulnerable state. So many cases of negligence and harmful disrespect for our seniors have plagued our healthcare system and it's long overdue for advocates to step up and defend them. Seniors should be our most respected members of society-- it's time we provide them the support they need."

Mad Dog Donald Trump Has A New Target-- Vulnerable Seniors In Long Term Care Facilities

What's more exciting, watching the new season of Game of Thrones or the new season of the Señor Trumpanzee Presidency? Remember, though, while we're being distracted by the outrageous antics of America's first-ever kakistocracy, they're working behind the scenes to chip away at everything that makes America great... little by little, relentlessly. Their latest victims: residents of nursing homes. No, really... that's who the Regime is going after now (No, not MS-13, seniors in nursing homes.) The audio above ran on NPR's Morning Edition yesterday.

What Trump wants to do-- well it's what the Chamber of Commerce wants to do but Team Trump is doing the dirty work for them-- is take away the right of abuse and negligence victims' right to sue nursing homes by forcing them to agree to arbitration rather than jury trials. 17 state attorney generals--led by Brain Frosh (D-MD) and Xavier Becerra (D-CA)-- and 31 senators-- led by Ron Wyden (D-OR) and Al Franken (D-MN)-- and the AARP are trying to stop Trump but he now seems to have gotten it in his mind that targeting nursing home patients is something he needs to stand firm on.

Long before he was a congressman, Alan Grayson wrote his masters thesis at Harvard on gerontology and then founded and ran the non-profit Alliance for Aging Research, after serving as a law clerk for both Ruth Bader Ginsburg and Antonin Scalia! Elder-care has always been one of the portfolios of issues that has driven his political career. He helped write the Medicare-For-All legislation and worked to try to persuade the leaders of both parties to include the care of teeth, eyes and ears in Medicare. When that eventually happens-- and it will-- we'll have Grayson to thank. There is no political leader who gets more incensed over elder-abuse than Grayson, so I went right to him when I saw what Trump is trying to do with these new rules. "It’s just typical of the kind of regulatory 'initiatives' that you see whenever the GOP has power," he told me this morning. "They pay lobbyists billions of dollars a year to generate this kind of malicious garbage, and press the buttons to have it proposed in the Federal Register, 'dropped' as a bill in Congress, inserted into the 'legislative history' of an appropriations bill, etc. In this case, it’s particularly malicious though, because Trump will never find himself in any 'long-term care facility,' unless it’s a federal prison."

Robert Pear covered the ugly news for the NY Times last week, as the Regime brings "its campaign to relax federal regulations to the delicate business of care for older Americans."

The push would undo a rule issued by the Obama administration that would have prevented nursing homes from requiring that consumers agree to resolve any disputes through arbitration rather than litigation. Nursing homes routinely require consumers to sign an arbitration agreement as a condition of admission to the home.

The proposed rule brings together a broader private-sector effort to slip binding-arbitration clauses into the fine print of consumer contracts with the Trump administration’s expansive efforts to roll back regulations and reduce the costs to businesses.

But both matters are particularly sensitive when it comes to older Americans, especially those in nursing homes where such arbitration agreements have already blocked legal recourse, even in egregious cases. About half of nursing home residents have Alzheimer’s disease or other dementia, according to the National Center for Health Statistics, and consumer advocates say harried family members could easily miss the arbitration clauses as they move a loved one into a home offering care.

“Individuals are very vulnerable when they sign contracts to enter a nursing home,” said Kimberly A. Valentine, a lawyer in Orange County, Calif., who has represented scores of nursing home residents. “In many cases, they are transferred from a hospital, and they are in a nursing home bed for several days before the contracts are even signed. The arbitration agreement may be just one page in a voluminous contract of 30 to 40 pages. Most of the people who come to me have no idea they’ve even signed an arbitration agreement.”

The Obama administration tried to ban such agreements, saying it was “almost impossible for residents or their decision-makers to give fully informed and voluntary consent to arbitration before a dispute has arisen.” Poor or negligent care at some nursing homes has persisted, even after the facilities have attracted regulatory scrutiny.

But the Trump administration says the ban on arbitration agreements imposes “unnecessary or excessive costs on providers” of nursing home care. It noted that President Trump, in an executive order, had directed agencies to roll back rules and reduce “regulatory costs.” The Centers for Medicare and Medicaid Services cited that guidance from the White House in issuing the new proposal.

“Upon reconsideration,” the Trump administration said of the proposed nursing home rule, “we believe that arbitration agreements are, in fact, advantageous to both providers and beneficiaries because they allow for the expeditious resolution of claims without the costs and expense of litigation.” The money that nursing homes spend on lawsuits could be better used caring for patients, it said.

Nursing homes generally welcomed the proposal, but other reaction has been overwhelmingly negative.

...Nursing home inspectors have documented many cases in which patients were injured as a result of infected bedsores, medication errors, malnutrition, dehydration or sexual assault.

The ban on arbitration agreements was issued by the Obama administration in September 2016. Nursing homes challenged it in court, and Judge Michael P. Mills of the Federal District Court in Oxford, Miss., blocked enforcement, pending a trial on the merits of the case.

But, Judge Mills said, “the practice of executing arbitration contracts during the nursing home admissions process raises valid concerns, on a public policy level, since many residents and their relatives are ‘at wit’s end’ and prepared to sign anything to gain admission.”

Long-term care ombudsmen, who receive federal funds to serve as advocates for nursing home residents in each state, are skeptical of the new initiative. “The proposed rule would undermine the rights of people living in nursing homes-- rights established in a 1987 law,” said Patty Ducayet, the Texas ombudswoman, who is a state employee.

The Trump administration has also proposed several requirements to protect nursing home residents who agree to binding arbitration. For example, arbitration agreements would have to be written in “plain language” and be explained to the consumer “in a form and manner that he or she understands.”

The innocuously-named American Health Care Association represents nursing homes in Washington and bribes members of both parties. The top recipient of their "contributions" last cycle was Todd Young, then a House Republican, now a Senate Republican. They always give more to Republicans but they also write checks for the most corrupt of the conservative Democrats from the Republican wings the Democratic Party. Among their biggest investments last cycle were corrupt scumbags on the blue side of the aisle:

• Joe Crowley (D-NY)
• Steny Hoyer (D-MD)
• Ben Ray Lujan (D-NM)
• Patrick Murphy (D-FL)

Each got the same $10,000 PAC check that was given to:

• Paul Ryan (R-WI)
• Rob Portman (R-OH)
• Greg Walden (R-OR)
• Cathy McMorris Rodgers (R-WA)

Two years early their biggest investments went to sleaze bags Cory Booker (D-NY- $15,000) and Fred Upton (R-MI- $15,000). they give especially large sums to Blue Dogs and New Dems and anyone else who has the reputation for selling their votes for a few thousand dollars... in a bipartisan way, of course. On Monday the National Law Review noted that "The current administration has set its sights on another federal rule, seeking to eliminate the ban on pre-dispute arbitration agreements for nursing home residents. Pre-dispute arbitration agreements require elderly adults and individuals with disabilities, as well as their families, to waive their right to file a lawsuit in the courts – before admission to a nursing home. As a condition to entering the nursing home, the prospective resident and his or her representative would be required to submit any dispute, including claims of egregious abuse or neglect, to mandatory arbitration proceedings."

Nursing home admission is a stressful and emotional time for the prospective resident and his or her family. Requiring a waiver of rights as a condition of admission, as occurs with pre-admission arbitration agreements, puts the person and his or her family in a time-sensitive quandary, literally at the nursing home door. Under the new amendments, if they refuse to sign away their right to go to court, they can be denied admission to the facility.

Imagine after months of discussions, the decision is finally reached to admit an elderly or disabled individual to a nursing home. This decision often involves the heartache of giving up one’s home and freedom, many possessions, and even treasured pets. The decision is often motivated by a desire to keep the individual safe and ensure that he or she receives required medical care.

But, are nursing home residents safe when they are required to sign away any right to legal accountability for mistreatment or harm in the facility?

Arbitrations take place in private meetings and are confidential. Because arbitrations are not public proceedings like lawsuits and trials, nursing homes have little to fear in terms of lost business or reputation, even if the arbitrator rules against them. To make matters worse, usually the pre-admission arbitration agreements give all the decision-making about the process to the nursing home, including selecting the arbitrator, location, and rules that will govern the proceedings. That removes other safeguards provided by the original rule such as choosing a neutral arbitrator.

The Journal points out that what Trump is doing is "to strip nursing home residents of that right [a jury trial] by removing the provisions prohibiting binding pre-dispute arbitration in long term care facilities," claiming the Obama rule would "likely impose unnecessary or excessive costs on providers."

We reached out to Dr. David Gill, the progressive candidate for Illinois' 13th congressional district. He told us that "As an emergency department physician, I frequently work with social services personnel to facilitate transfer of patients from the emergency department to nursing homes, in situations in which patients can no longer care for themselves at home but are not so acutely ill as to require inpatient care in the hospital. This is an extremely stressful time in the lives of patients and their family members, and it amazes me that our government would seek to take away the rights of these patients and families at such a pivotal moment in their lives. Given the frequent difficulty in obtaining a nursing home bed in these situations, it is extremely unlikely that a family would refuse to sign the waiver being proposed by the Trump administration. To take advantage of individuals in such dire circumstances is shameful, to say the least. I am running against a representative who stands firmly with the president on virtually all matters, and I look forward to replacing him in January of 2019, and bringing compassion and my knowledge gained through 30 years in the healthcare profession with me to Congress."

James Thompson is running for the KS-04 congressional seat, but he's better known as one of Kansas' top civil rights attorneys. This is right in his wheelhouse. He told us that "Arbitrators can play an important role in ending litigation when both sides possess equal bargaining power and agree to arbitration. However, these efforts to deny the right to a jury trial and force arbitration are nothing more than big corporations operating from dominant positions in the business relationship and attempting to deny individual working class Americans a means of redress when nursing homes choose profits over people. Arbitrators are paid on a regular basis by big corporations who have numerous disputes, which provides a financial incentive to rule in favor of big corporate interests. Big corporations weed out arbitrators that rule against them by refusing to use them, while often going back to favorable arbitrators. We need to fight laws that take power from working Americans to give that power to corporate interests."