Tuesday Morning Male Beauty

Nursing Homes Were a Disaster Waiting to Happen Long Before Covid-19

Nursing homes are places to be avoided if at all possible and even having money and being placed in a "good facility" doesn't guarantee one will receive proper care (this happened to a friend last year), especially since many nursing homes are for-profit operations and maximizing profits is the number one concern despite lip service to the contrary.  There are state and federal standards that strive to enforce safety for patients and these were strengthened in 2016 under the Obama administration only to be weakened one year later under the Trump/Pence regime which time and time again places money making big business ahead of the safety of citizens (other examples are the gutting of clean air and clean water regulations). The sad reality is that too often, going to a nursing home is going to a place to die unless one is going for short term rehabilitation.  Most are understaffed and simple measures to avoid infection are all too often ignored.  A column in the New York Times looks at the state of nursing homes which have accounted for 25-27% of all Covid-19 deaths - perhaps more if accurate reporting was required nationwide.  Here are article excerpts:

It was clear almost from the outset that the elderly and frail were in the greatest danger from Covid-19. And it was clear to anyone familiar with American nursing homes that these facilities would not be up to the task of protecting their older and infirm residents.

As of Thursday, Covid-19 has killed over 10,000 residents and staff members in long-term-care facilities in 23 states that report fatality data, about 27 percent of the Covid-19 deaths in those states, according to the Kaiser Family Foundation.

The weaknesses in patient care and oversight at nursing homes that made those deaths more likely were longstanding, widespread and well known.

One-third of Medicare beneficiaries admitted to nursing homes suffer harm within about two weeks of entering the facility, according to a 2014 report from the federal Office of Inspector General. These are the short-term residents for whom facilities are paid the most and who are typically most able to articulate their concerns if something is wrong. Where does that leave a majority of residents who are in the facility long-term, most of whom are older, frail and cognitively impaired?

Despite the absence of federal reporting requirements, we are seeing that residents and families are being devastated by Covid-19. In New Jersey, an anonymous tip led authorities to a nursing home that was storing corpses in a shed. At least 29 of its residents have died from Covid-19 and many more residents and staff members have been infected. Unsurprisingly, this for-profit nursing home has a history of seriously low staffing and citations for substandard infection control.

The tragedy is that government standards of safety and care at homes certified under Medicaid or Medicare (a large majority) are strong. If enforcement of those standards had not been so lax, the devastation we have seen in nursing homes could have been mitigated.

The federal Nursing Home Reform Act of 1987, and the regulations and guidance through which the law is carried out, most recently revised in 2016, require effective infection control and prevention including hand hygiene and the use of personal protection equipment.The most important precautions against infection are inexpensive and simple, and the most common violations involve simple sanitation and hygiene practices, like hand washing. Nevertheless, infection control and prevention problems were the most frequently cited violation in nursing homes last year.

Such poor care persists because regulators let the nursing home industry treat standards of care as goals rather than actual requirements. The nursing home industry wields enormous influence in Washington and state capitals through multimillion-dollar trade associations, powerful law firms and generous contributions to politicians and political action committees. As a result, nursing homes, rather than nursing home residents, are often viewed by policymakers as the constituency whose interests merit protection. After President Trump was elected, the Centers for Medicare and Medicaid Services started openly referring to the nursing home industry as its “customer.”

Numerous federal and academic studies over the years have found that government inspectors do a poor job finding substandard care and, even when they do, are woefully disinclined to penalize a facility for it.

This is because of the persistent failure to identify when residents have been harmed or put in jeopardy. For example, while pressure ulcers (bedsores) are a potentially life-threatening concern for nursing home residents, proper care can prevent or minimize a vast majority of them. 

Nursing home industry lobbyists often claim that their clients cannot afford to improve conditions because they make so little money. In fact, the for-profit sector of the industry has been growing for years, belying the notion that it is not a profit-generating industry. Profit margins from Medicare reimbursements have been in the double digits for about 20 years, according to the nonpartisan Medicare Payment Advisory Commission. . . . . In addition, nursing home profits are increasing under the new federal payment methodology introduced last October.

So we can’t accept industry excuses about costs or give in to Trump administration efforts to undermine regulatory standards and reduce the already low frequency of inspections. Instead, existing standards need to be more strictly enforced, and tougher standards need to be put in place. Residents’ lives depend on it.

Federal minimum staffing standards are long overdue. A study in 2001 determined that the typical nursing home resident needs about 4.1 hours of care each day just to meet his or her basic clinical needs (not to mention live with dignity). The average facility reports only 3.7 hours per resident per day.

The pandemic has made this worse.

We need to establish how much Medicare or Medicaid funds go to care and limit how much revenue nursing homes can siphon into profits, unrestricted administrative expenses or unaudited contracts with companies they control.

While reimbursement rates for Covid-19 patients are very high, there are no requirements that those funds be used to buy protective equipment, boost staffing or help residents get through this crisis.

A pandemic is a force of nature that cannot be avoided. But years of neglect by nursing homes have left millions of older residents unprotected from it. Many of the deaths we’ve seen could have been prevented. More lives can be saved if we demand more from the industry and from its regulators.

More Monday Male Beauty

Why Trump Failed America

If one is honest, looks at the facts, all of Trump's lies, and considers all the ways that the Trump/Pence regime weakened America's ability to meet the Covid-19 crisis  - e.g, disbanding the National Security Council pandemic directorate, slashing funding for the CDC, and rescinding Obama era regulations for nursing homes that might has slowed the spread of the virus among the  nursing home residents - the only conclusion is that Trump has spectacularly failed America. But even beyond all of this, there is an added reason for Trump's failure: he is a malignant narcissist who lies incessantly and cares only about himself and satiating his unquenchable ego.  All the warning signs were on open display ranging from his boasts about "grabbing p*ssy" without consequence to being able to shoot someone on 5th Avenue without consequence.  Sadly, Trump's calls to racism and religious extremism were followed by many who should have known better even as Democrats in a funk stayed home and by default voted for Trump.  A column at CNN looks at all of this and Trump's very nature that guaranteed his huge failure to safeguard America.  Americans should never again put someone with Trump's mental and psychological illness in the Oval Office - or any high office.  Here are column excerpts:

Watching President Donald Trump wrestle with this epic crisis reminds me of the old fable about the Scorpion and the Frog.

You'll remember that the scorpion asks the frog for a ride across a river, only to sting the frog when they are midway across. When the startled frog asks why the scorpion would repay his kindness so cruelly and kill them both, the scorpion shrugs. "It's my nature." Trump could have made this unparalleled and agonizing trial for our country an occasion for personal triumph — if he were only able to take the personal out of it. But that is not his nature.

This moment of extraordinary pain and crisis calls for steadiness and sobriety; empathy for the widespread pain and suffering of others; absolute transparency; a willingness to listen and learn; and rigorous, disciplined attention to detail. None of these qualities are within his nature.

Many governors across America have enhanced their popularity simply by doing their jobs during this deadly outbreak of the coronavirus. Even in a polarized nation, it might have been the same for Trump if, from the start, he had leveled with the country about the nature of the threat, followed expert advice and made the case for the painful and decisive steps required to save lives.   But that's not his nature. Instead, the [Trump] President spent six weeks dismissing the threat and offering false assurances as public health experts frantically warned what was to come.
 Trump ostensibly feared that an acknowledgment of the severity of the virus and the draconian steps required to protect Americans would tank the stock market and the economy, which he had hoped to make the springboard to his re-election. So he insisted on an alternative storyline. US cases would not surpass 15, he said in February, even as some public health experts warned of a potential pandemic. "Miraculously," he suggested with a flourish, the virus could just fade away with a change in the weather.
 As Covid-19 had begun its deadly march across the nation, Trump was accusing Democrats and the media of politicizing the disease in what amounted to a Coronavirus "hoax" to damage him.

While some governors were mobilizing against the threat, [Trump] the President sent the nation and federal bureaucracy the opposite signal, delaying the necessary steps, which cost the nation valuable time to gird for the battle and deepened the crisis.
 Since the day he finally recalibrated, appearing at the podium in the White House briefing room in March to declare war on Covid-19, [Trump] the President has spent most of his briefing time spinning his administration's uneven and tardy response (which he rated a 10 out of 10) rather than giving the American people the sober and accurate assessment they need. Truth and accountability are not his nature. Americans of all stripes are bound together by a common calamity, hungry for a unifying leader who will rise above partisanship. But that is not Trump's nature. He has suggested that governors, desperately asking the federal government for more testing supplies, were acting out of political motivation.
 Trump is who Trump has been from the beginning of his long career in the public eye: a super narcissist and shameless self-promoter, unwilling to accept responsibility or the truth and unable to think about anyone but himself. If he had been more in this historic moment, it would have done so much to strengthen his brand and his prospects of reelection -- not to mention comfort his wounded country. But it is no surprise that he could not. It's just not his nature.

McConnell’s Rejection of Aid for States Risks Causing a Depression

McConnell: worse person in Washington?

There are few individuals in Washington, D.C., more evil than Mitch McConnell - Trump is perhaps the only one worse.  McConnell had no problem giving a $1.5 trillion tax break to the wealthy and large corporations, most of which used the funds to buy back stock and further enrich their senior officers. Likewise, McConnell and his wife have used their positions to secure all kinds of sweetheart deals and enrich themselves.  Now, with the nation in the grip of a pandemic, McConnell says he would prefer states go bankrupt - cutting all kinds of essential services upon which citizens depend - rather than provide federal aid to states.   When it comes to helping states and average Americans, McConnell's response is "f*ck you" and/or "go die." The man is despicable and has done extreme damage to the nation.  If anyone needs to be stricken by the virus, I'd nominate McConnell.  A piece in the Washington Post looks at McConnell's reckless insanity.  Here are excerpts:

Senate Majority Leader Mitch McConnell (R-Ky.) would rather see states declare bankruptcy than give them federal aid to deal with the economic collapse triggered by the coronavirus pandemic.

That’s a recipe for turning a potentially short recession into a prolonged depression, according to officials and analysts.

The question of whether Congress and the White House should provide relief funding to state and local governments — as the feds have done already for private business — is about to reach a showdown in Washington.

The stakes are high in our region, where state and local officials say that without federal action they will have to make even deeper cuts than feared in core services such as education, housing and health programs (apart from those required to fight the virus).
Governors, mayors and county leaders of both parties are clamoring for help in the next federal rescue package after McConnell and President Trump blocked such assistance in the $484 billion bill approved last week.

Maryland says the shutdown could cost it as much as $2.8 billion in lost tax revenue in just four months — from March through June.

“I would describe this as worse than the 2008-2009 recession,” Franchot said. “That was a huge fiscal and monetary catastrophe, but we didn’t see 340,000 Marylanders file for unemployment in three weeks.”

In an earlier relief package passed last month, Congress approved $150 billion for state and local governments — but with an important condition. It said the money could be spent only to cover new costs of fighting the virus, and not to replace revenue lost because of the economic slump. State and local leaders are calling for the next bill to eliminate that restriction.

“We’re not going to get out of this pandemic and this budget mess unless the people on the ground instead of people in Washington, D.C., are given flexibility to use the money as they know how to help the economy recover,” Fairfax County Board Chairman Jeff C. McKay (D-At Large) said.

Fairfax is projected to lose at least $165 million over 12 months because of plunging sales tax receipts and other effects of the shutdown. It already has dropped plans to increase spending on affordable housing, early-childhood education and police body cameras.

They [Republicans] said they feared that states and localities would move more slowly to reopen their economies if they received federal assistance. State and local leaders retorted that they will open their economies as soon as public health authorities say it’s safe to do so.

The other argument against federal aid, voiced by McConnell, is that it would bail out states that he said have mismanaged their finances in the past, such as by incurring large pension obligations for teachers and other public employees. In a radio interview Wednesday, McConnell suggested instead that states declare bankruptcy.

The comment drew widespread backlash.

“This is grossly irresponsible with a naive sense of what state and local governments do,” tweeted Amy Liu, director of the Brookings Metropolitan Policy Program. “Without emergency relief as their revenues crater, state and local governments will not be able to run key programs like unemployment insurance, social services, housing assistance and small business outreach needed to protect people and businesses in this crisis.

“If you want to send the country into an extended depression, sending state and local governments into bankruptcy is a great way to do it,” said a local government budget expert, who spoke on the condition of anonymity because they were not authorized to speak publicly.

Our region’s state and local governments are bracing for severe spending cuts, with the burden expected to fall heavily on two areas that make up a large part of their budgets — education and health care.

Virginia has already suspended plans to increase spending on K-12 education by $540 million over two years, higher education by $356 million and Medicaid by $207 million.

The District is projected to lose $1.5 billion in revenue over the next 17 months. Barring substantial federal aid or tax increases, cuts are expected to fall heavily on affordable housing, education and services that help low-income residents, according to Tazra Mitchell, policy director of the D.C. Fiscal Policy Institute.

McConnell’s attacks on states’ fiscal management drew sharp rebukes from area officials. They noted that Virginia, Maryland and the District also have Triple-A bond ratings. Additionally, states, unlike Congress, are required to balance their budgets.

McKay noted: “Fairfax has a Triple-A bond rating and a balanced budget. Compare that to Mitch McConnell’s record on deficits. It’s laughable.”

Monday Morning Male Beauty

More Sunday Male Beauty

Closed Hospitals Leave Rural Patients ‘Stranded’ as Coronavirus Spreads

Map of where the nearest hospital is more than 30 minutes away.

Many red states chose to NOT expand Medicaid under the Affordable Care Act and one consequence has been the closure of many rural hospitals, leaving many rural residents with no nearby hospital.  In a medical emergency, having a hospital nearby is literally a matter of life and death - something I learned years ago when one of my children was stricken with bacterial meningitis.  We lived at the time about 5 minutes from a large hospital with a trauma center ER.  We had a positive result and full recovery.  Had the hospital been 30 minutes or more away, things would have been horrifically different. Now, with the Covid-19 pandemic still raging - cases are still rising in Virginia and many other states - many rural residents are finding a serious lack of hospital access.  The irony, of course is that many of these same areas support Republicans (usually because of GOP calls to racism and religious extremism) whose policies have exacerbated the lack of local hospitals. Talk about voting against one's own best interests! A piece in the New York Times looks at the predicament rural Americans are facing.  Here are highlights: 

Michael Nuzum had spent weeks fighting coronavirus-like symptoms — a wracking cough, terrible chills, an exhausting fever — before collapsing at his home in rural West Virginia.

Mr. Nuzum, a 54-year-old animal control worker, was already in cardiac arrest when the emergency workers arrived on April 3. That left them with a difficult decision: Should they transport their patient to the nearest hospital, 30 minutes away?

“There’s only so much one paramedic can do in the back of an ambulance,” said Michael Angelucci, who leads the Marion County rescue squad that cared for Mr. Nuzum. The two-person team that responded decided it couldn’t risk the long ride and instead tried to revive the patient at the scene. But the workers couldn’t save him.

Two weeks earlier, the options would have been different. Fairmont Regional Medical Center, just five minutes from Mr. Nuzum’s home, would still have been open. Mr. Angelucci, who is also a state representative, can’t help wondering if the hospital and its emergency room could have given the man a fighting chance.  “It’s incredibly frustrating that this entire community is stranded without a hospital,” he said.

Fairmont was one of three hospitals that have shut down in this corner of rural West Virginia and Ohio since September. They delivered hundreds of babies each year, treated car crash and gunshot victims, repaired hearts and knees and offered addiction treatment and psychiatric care.

They had been acquired by a for-profit company, Alecto Healthcare Services, beginning in 2014. Employees expected the new ownership to put the institutions on solid footing after years of financial struggle. Instead, decisions made by Alecto wound up undercutting patient care and undermining the hospitals’ finances, according to more than two dozen interviews with doctors, nurses, other staff members, government officials and patients, as well as a review of court records.

Finally, one after another, the three hospitals ceased operating. At the request of the governor, the West Virginia attorney general’s office is investigating the company’s decision to close them. The shutdowns . . . . have forced the region to fight a coronavirus outbreak with 530 fewer licensed hospital beds than it had a year ago. Across the United States, hospitals serving rural areas have spent decades trying to provide medical care and produce enough revenue to stay open. They have closed in increasing numbers in recent years as local populations have declined. About 170 rural hospitals have shut down since 2005. [F]or-profit hospitals are more likely to close than the others, one recent federal study showed. It found that for-profit facilities accounted for 11 percent of rural hospitals but 36 percent of closures among the group. Within the past year, rural hospitals have closed in Pennsylvania and Tennessee after selling to for-profit chains. Ms. Horwitz’s research found that for-profit rural hospitals were less likely to offer needed but unprofitable medical services, such as hospice and inpatient psychiatric care.

“The goal of the for-profit is to make money,” Ms. Horwitz said. “That doesn’t mean they’ll do anything to make a buck, but they have a different goal from nonprofits.”

Alecto’s hospitals generally serve low-income communities, with most patients covered by Medicare or Medicaid. In Marion County, for example, the population once served by Fairmont has higher-than-average smoking and obesity rates. The state also had the country’s highest rate of drug overdose deaths in 2018. West Virginia University’s health system, about 12 miles from Fairmont, plans to reopen part of the Fairmont hospital but will not be able to do so until late May.

For now, the three communities face a stretch of months where hospital beds could be scarce in the midst of a global pandemic. Jennifer Henderson Hayes, who was the chief pharmacist at East Ohio, now works at the remaining hospital in Wheeling.

She has already seen greater strain on the emergency room there. “You see people, potentially sick with Covid-19, waiting for eight or 12 hours just to be seen.”

For profit hospitals are a problem in my opinion.  Years ago when I worked for a law firm that represented a non-profit hospital system, administrators regularly complained that the for profit Humana hospital 20 minutes away would send uninsured patients by taxi to the non-profit hospital rather than treat them. 

Sunday Morning Male Beauty

Why Cocktail Hour Is Back

A French 75.

A piece in the New York Times looks at the revival of cocktail hour as many of us are working from home and/or seek a release from the subtle stress of living in a pandemic where you must treat everyone you meet as potentially contagious, wearing a mask and wiping down everything with sanitizer (routine real estate closings I do have a whole new underlying element of stress).   Meanwhile, as a piece in the Virginian Pilot notes, liquor sales in Virginia and other states have skyrocketed and there is a new focus on cocktails (beer sales have increased nowhere near as much as hard liquor). As the Times piece notes, cocktail hour meets a need: "we need the ritual; we have the time; and during lockdown, it’s 5 o’clock everywhere."  I think cocktail hour also meets another need for many, especially those of us of a certain age: nostalgia and a sense of a better time when things and life were more certain. In my youth I still recall cocktail hour at our summer home as my parents and relatives had cocktails on the front porch overlooking the lake discussing family things, reminiscing, and discussing politics (always a constant in my family).  Here are article highlights:

“Is it too early to drink?” A few weeks into our current disorientation, that line or some jokey variation of it began to appear with a certain frequency on Twitter, in texts I’d get, in Slack messages, in my head.

I would encounter it, too, during long calls with friends that now followed a distinct sequence . . . resolving, invariably, with a conversation about last night’s cocktail and the plan for this evening’s.

One friend recently posted a picture of David A. Embury’s classic primer, “The Fine Art of Mixing Drinks,’’ published in 1948, on his Facebook page with the caption: “Homework.’’ Another friend, Jimmy, was making Palomas with a grapefruit soda created by a Los Angeles bartender, which was now sold out on Amazon and at Target.

If you told me at Thanksgiving that in six months we would all be confined to our homes and facing shortages of toilet paper and a cactus-infused organic citrus beverage, I would have hugged you and smiled, and quietly called your psychopharmacologist to suggest adjustments.

[I]n New York and many other states, liquor stores were deemed essential retail businesses on the premise that our anxiety was going to require release. But there was a growing need as well for new rituals to replace the ones that had vanished from our lives — for a style of drinking that was neither rushed nor indiscriminate, presuming we were of sound health and blessed with the structural comforts. Gulping down a glass of wine from a screw-top bottle as you frantically heated leftovers because you got home late from work, again, was a habit it no longer seemed necessary to honor.

My friend Nelson and his wife have suddenly found themselves in a nightly cocktail routine. He recalled the sanctity of his parents’ cocktail hour, growing up in Palo Alto in the 1970s, and tracked its waning dignity in the years that followed. How could any of us have imagined that a pandemic would revive it? According to a 1958 New York Times article, the institutionalization of cocktail hour in American life can be dated precisely to Dec. 5, 1933, when the 21st Amendment made alcohol legal again. Cocktails “and the late-afternoon hour devoted to them,’’ the article explained, were a direct result of the Prohibition-era practice of disguising the flavor of bathtub gin and other spirits with fruit juices. It’s hard to say when it ended, but the tech boom was one assassin. In my own life, the need to punctuate the end of the day at a moment when time feels so static has left me looking for the exclamation points. On many days, I will make a drink that requires precise measurements, special equipment, effort, the boiling of water, the dissolving of sugar — order and the promise of a particular certainty. Perhaps some during this period will develop bad habits that require their own cures. I hope that is not the case. Five o’clock is now a lot closer to bed time than it used to be. And a single cocktail can feel like the best inoculation against dread.

Yes, the husband an I had cocktails last night - and will again this evening.