Americans unprepared to pay for long-term care
Filed under: Aging, Government, Health care reform
In the Chicago Tribune, Deborah Shelton examines how unprepared Americans are to pay for their own long-term care needs as they age. Long-term care tends to slip under the radar because, as one of Shelton’s sources told her, “People buy insurance for their life because they know they are going to die, for their car because they know that can get in an accident and for their health because they know they can get sick, but people don’t tend to buy insurance because they think they are going to need someone to help them take a bath.”
Long-term care encompasses everything from nursing home fees to in-home assistance with everyday routines. It all comes with a price tag; Medicare only covers a limited amount and Medicaid programs apply only to those below certain economic thresholds. That leaves the middle class, who can’t afford the services but don’t really qualify for Medicaid, in the lurch, Shelton writes.
Most people assume Medicare will pay the bills, but the program covers long-term care only under certain conditions and for a limited time. While Medicaid covers long-term care, beneficiaries have to be poor or willing to “spend down” their assets to be eligible. Private insurance can be expensive and excludes applicants with serious medical problems.
As a result, many families pay out of pocket until they exhaust their resources and then turn to Medicaid.
The Affordable Care Act attempted to fill in the blanks, but long-term care provisions of that reform plan withered under intense cost pressure.
An initiative that would have incorporated long-term care into the Obama administration’s health reform plan was scrapped in October after actuaries determined that it would not be financially self-sustainable over the long haul. The Community Living Assistance Services and Supports Act would have created a voluntary, self-funded, employer-based insurance option to help people save for long-term care.
Related
Cash-strapped Ill. goes after hospitals’ nonprofit status
Filed under: Hospitals, Hot Health Headline, Public health
A New York Times article written by Bruce Japsen, an independent journalist writing for the Chicago News Co-Op, digs into Illinois’ recent challenges to the tax exemptions granted to a trio of prominent hospitals by virtue of their nonprofit status. The challenge, inspired in part by the state supreme court’s willingness to uphold the revocation of the nonprofit status of an Catholic hospital in Urbana last year, could expand to more than a dozen other institutions as the state scrambles to cover a looming revenue shortfall.
In its case, the state alleges that the hospitals aren’t providing a high enough proportion of charity care to fulfill the mission of a nonprofit.
All three of the hospitals the state is focusing on provided free and discounted medical care that ranged from 0.96 percent to 1.85 percent of patient-care revenue, according to the revenue department. The state also said that each one had been operating as a “for profit” business when the state’s Constitution says that “only charities are entitled to a tax exemption.”
The hospitals, for their part, point to the other benefits they provide the community, such as neonatal intensive care and burn units, that don’t always bolster their bottom lines. Advocates answer that paying taxes provides a community benefit as well, one that can readily be measured in dollars and cents. And Japsen found that paying those taxes doesn’t even seem to preclude the provision of charity care, especially at the parsimonious levels provided by the hospitals currently targeted by the state.
“The relative amounts of charity care provided by not-for-profit tax-exempts are not materially different from the amount provided by for-profit hospitals,” said Jim Unland, a longtime analyst of Illinois’ health care industry and president of the Health Capital Group, a consulting firm in Chicago. “This raises the issue of whether the tax-exempts are getting prejudicially favorable treatment.”
The three hospitals whose tax exemptions have been stripped by the state department of revenue plan to challenge the action in court, and state hospital organizations are gearing up for a lobbying push they hope will put their tax status on firmer ground.
St. Louis reporters find felons practicing medicine
Filed under: Health care reform, Hot Health Headline
The St. Louis Post-Dispatch’s Blythe Bernhard and Jeremy Kohler tell the story of an ophthalmologist to show how a convicted felon can be allowed to return to medical practice, sometimes in the same state in which he or she was convicted. The ophthalmologist in question went to prison after lying to patients, defrauding Medicare and obstructing the resulting investigation, yet now works in an Illinois clinic and has permission to reapply for his Missouri license.
The investigation is strengthened by two sidebars, one listing examples of other felons/physicians and the other explaining how and why an ophthalmologist lied to patients and Medicare about what he was injecting into their eyes.
For the record, my favorite sentence in the entire piece is “Medical boards don’t release statistics on how many active licensees are convicted felons.” It certainly would make things easier.
Earlier stories from Bernhard and Kohler document similar problems with a lack of openness of records and how disciplined doctors can still keep their records clean:
AHCJ members can read about how the pair have done much of the reporting on this ongoing project.
Community-led effort sparks public health wave
Filed under: Health policy, Hot Health Headline, Public health
Writing in The New York Times, Jessica Reaves writes about how a 2000-06 Chicago community survey embodies the block-by-block, community-reliant approach to public health that it helped inspire.
In the heavily Puerto Rican Humboldt Park neighborhood, researchers worked with community leaders to write study questions, then relied on community members to conduct the actual survey. From these roots, the level of community participation snowballed, and locals demonstrated an interest and investment in public health that researchers hasn’t seen before. Today, initiatives born out of that study still provide residents with access to fresh produce, free diabetes screenings, fitness classes and more.
Now, researchers are further localizing and intensifying their effort with a block-by-block approach. The Humboldt Park model has become one that others are working to replicate across the country.
The specifics of the Sinai approach (In Humboldt Park) — change-oriented and invested in the fate of a neighborhood — are distinctive, but they also reflect a sea change in the overall strategy of public health professionals, said Janine Lewis, executive director of the Illinois Maternal and Child Health Coalition, a nonprofit advocacy organization in Chicago.
“I think the field is becoming more responsive to the idea of community-based participatory research,” Ms. Lewis said. “Those of us in the field realize that community members are experts on the needs and gifts in their communities, and should be consulted” at every phase of research.
This approach, she added, not only helps investigators devise more meaningful questions, but also means residents feel a part of the process and motivated by the results.
Outpatient inspections show serious lapses
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public records, Studies
AP medical reporter and AHCJ board member Carla K. Johnson used FOIA requests to uncover a wealth of infection-control violations at outpatient clinics in Illinois. The majority of Illinois ambulatory centers have yet to be inspected under the tough new rules, but 76 percent of those which have been inspected also have been cited. The inspections are part of a national push to increase the oversight of ambulatory care centers.
Previously, inspectors from the Illinois Department of Public Health visited the centers about every seven years. But the state last year began more vigorous and frequent inspections of outpatient surgery centers, following directives from national health officials. The state now plans to inspect a third of Illinois centers each year, said Karen Senger, a supervisor in the Health Department’s Division of Health Care Facilities and Programs.
The crackdown resulted from a hepatitis C outbreak in Las Vegas believed to be caused by unsafe injection practices at two now-closed clinics.
Johnson’s state request turned up a laundry list of specific violations, all of which she summarized in one nifty sentence: “The five-second rule appears to be alive and well in Illinois same-day surgery centers, where medical staff were observed picking up items that had fallen to the floor and behaving as if they weren’t contaminated by germs,” Johnson wrote. In an e-mail to Covering Health, Johnson said her story should be easy to localize and explained just how she obtained the inspection reports and why they are now available.
I FOIA’d state inspection reports (CMS-2567s) for ambulatory surgery centers in Illinois that were cited for deficiencies in infection control during the past 12 months. States have been directed by HHS to use a new audit tool to look for infection control problems, following an outbreak linked to two centers in Las Vegas.
Foe of degree mills sets sights on medical school
David Wolman, writing in Wired, chronicles the efforts of an Illinois physics professor, George Gollin (bio), to topple a $7 million fake-degree empire. It’s a fun story, and well worth a read, but the part that will most interest health journalists pops up at the very end: The professor who took down the operation that granted about 9,600 fake degrees used by everyone from schoolteachers to Bush White House staffers is now looking into what he thinks is a phony online medical school.
Wolman ends with this sketch of the professor at work:
He erases equations from a blackboard and scribbles a spider’s web of names, notes, and online sites all relating to an outfit called St. Luke School of Medicine, which he believes sells bogus medical degrees. “You get a real rise out of people when you talk about fake MDs,” he says.
The outfit in question, St. Luke School of Medicine, has now posted a message announcing it’s no longer accepting new students. However, if Gollin’s previous work (in his own words) is any indication, St. Luke is probably just one entry point into a universe of dubious medical degrees.
NOTE: As the Wired story makes clear, media outlets played a major role in the effort to expose the first diploma mill, especially by shaming public institutions into investigating and prosecuting the offenders. Reporters like The Spokesman-Review’s Bill Morlin and Jim Camden helped connect the dots and expose the full reach of the story.
Tribune investigates nursing home psychiatrist
In the latest installment of the Chicago Tribune’s investigation into Illinois nursing homes, Sam Roe and ProPublica’s Christina Jewett investigate Dr. Michael Reinstein, an impressively prolific prescriber who, in 2007, wrote more prescriptions for clozapine (”a potent psychotropic medication that carries five ‘black box’ warnings”) than all physicians in Texas put together.
In that same year, he prescribed medications to 4,141 Medicaid patients. Furthermore, while the average American doctor sees about 35 patients each with, Reinstein sees an incredible 60 patients each day. Reinstein’s workload may have something to do with the fact that he’s the psychiatric director at 13 different nursing homes, but Roe and Jewett write that the ultimate blame lies on systemic problems in Illinois.
Earlier
New slim guide:
Covering the Health of Local Nursing Homes
Check out AHCJ’s latest volume in its ongoing Slim Guide series. This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
Recent workshop
AHCJ’s Aging in the 21st Century workshop, held Oct. 16 and 17 in Miami, addressed many topics raised by the Tribune’s reports, as well as the changing picture of aging Americans and key research and issues related to this growing population. Tip sheets and presentations from that workshop are available to AHCJ members, as are these related tip sheets:
- Aging Nation: Troublesome Health Care Issues
- Headlines an advocate for seniors would like to see
- The impact of aging upon health care
- Covering nursing homes and other issues of aging
- How will retiring boomers affect the national health agenda?
- You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
- Biology of Aging: Sources and Resources
Is community research oversight flawed?
Filed under: Government, Hospitals, Hot Health Headline
America’s 400-plus designated Community Research Sites receive much less attention than the massive academic research hospitals, but conduct the bulk of the nation’s cancer research.
The New York Times’ Duff Wilson turns the spotlight on these sites, considering problems an HHS investigation uncovered at an institution in Urbana, Ill., that may show that oversight is lacking and “the community centers may not always be adhering to the rigorous protocols of research medicine that the National Cancer Institute expects them to follow.”
If that’s true, Wilson writes, it will draw the very validity of many research conclusions into question. If you’re curious about the specific nature of the research site’s violations rather than the larger systemic implications, check out the second page of Wilson’s story.
Trib looks into dangerous nursing home residents
The Chicago Tribune’s Gary Marx and David Jackson examined the effectiveness of Illinois regulations implemented in 2006 to protect nursing home residents from potentially dangerous peers. They’ve pulled together some alarming anecdotes and data that show the law is not as effective as hoped.
For example, the reporters focus on the man with a criminal record who attacked by another resident with an ice pick. Just a year after the attack, he ended up in the same facility as his victim again. This time, he slashed him with a box cutter. Obviously, there was a hole somewhere in the new system. Marx and Jackson lay out the facts:
With growing numbers of mentally ill felons entering Illinois nursing homes, the state in 2006 became the first to require criminal background checks as part of an overall risk assessment of new residents. The screenings by state contractors are used to identify high-risk individuals who should live in private rooms and be closely monitored.
But a review of confidential reports in 45 recent cases shows that in many instances the assessments were incomplete, leaving out some criminal convictions and other crucial details.
The project includes a searchable database of safety reports on nursing homes in Illinois, including information not searchable on government sites. Readers can use the database to find out the number of residents at a facility who are convicted felons and sex offenders, crimes reported at Chicago nursing homes and fines levied because of deficiencies in care. Head over to the investigation’s homepage to follow the story and its results.
Barriers in 5 Midwest states chill public access
A study from the the Citizen Advocacy Center finds that open government laws in Michigan, Ohio, Illinois, Wisconsin and Minnesota have systemic barriers that chill public participation and access to government.
The Center analyzed each state’s Freedom of Information and Open Meetings Acts and found striking similarities between all states, including:
- Open government laws are sporadically enforced, which means public bodies are more likely to be unresponsive to records requests and employ exemptions to keep meetings closed.
- No state surveyed has a government office with statutory authority specifically created to oversee and enforce sunshine laws.
- State employees are not adequately trained to carry out open government policies and may be unintentionally violating the laws.
- Citizens may be able to attend meetings, but there are very few opportunities to participate.
The Midwest Open Goverment Project is a comprehensive study of the Freedom of Information and Open Meetings Acts in those five states, under the auspices of the Citizen Advocacy Center.
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Join us in Atlanta
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New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
