Oct. 1st: 11.1% rate slash will be applied to Medicare payments to nursing home facilities.

[madfloridian]

I guess it is really true. Seniors and disabled are really truly going to have shared sacrifice with billionaires. Funny thing, though, there is almost no discomfort at all to the billionaires.

I had heard these facilities were almost in panic about Medicare cuts already being made. I did NOT know about this 11.1% cut. Not much in the news about it either.

Nursing home operators are now looking for ways to cut spending in preparation of Medicare budget cuts that will take effect Oct. 1. The 11.1% rate slash will be applied to Medicare reimbursements paid to nursing home facilities that provide post-acute care and the news is shaking industry at all levels. Industry stock prices plummeted on the news, plans for new facilities are being abandoned and large facility operators are scrambling to offset what will amount to tens of millions of dollars in unreimbursed costs. For more on this continue reading the following article from National Real Estate Investor.

Here is more about the drastic cuts coming Oct 1.

Elder Care Facilities Floored by Medicare Cuts

The nursing home industry suffered a startling setback July 29 when the federal government announced that Medicare rates will be slashed by 11.1% starting Oct. 1.

The unexpected rate cut has sent nursing home operators scrambling to figure out how to pare expenses. Stocks of publicly traded nursing home companies plummeted by as much as 50% on the first day of trading after the announcement.

.."“We were stunned by the announcement,” says John Taylor, president and CEO at Stonegate Senior Living, a Texas-based nursing home developer and operator. “We did not expect this.”

The cuts are being made to Medicare reimbursements paid to nursing facilities for seniors receiving post acute care. This care is provided to Medicare recipients recovering from surgery or an illness who require rehabilitative services before retuning home.

This is shocking from a Democratic administration. Here is more about how these cuts will cripple home health care agencies.

..."Large adjustments to home health payments will have a significant and alarming impact on the financial viability of home health providers, says NAHC, which could threaten access to a system of care that many seniors prefer.

CMS contended in its proposal that the adjustment was warranted because there has been limited change in patient acuity in the past few years, but NAHC countered by saying there is strong evidence showing patients to be sicker than ever and in need of the extensive care that has made care costs rise significantly.

J.K. Galbraith had some powerful words recently about liberals and progressives standing up for things that are vital.

What is at stake in the long run? Two things, mainly, in my view. First, it seems to me that we as progressives need to make an honorable defense of the great legacies of the New Deal and Great Society -- programs and institutions that brought America out of the Great Depression and bought us through the Second World War, brought us to our period of greatest prosperity, and the greatest advances in social justice. Social Security, Medicare, housing finance -- the front-line right now is the foreclosure crisis, the crisis, I should say, of foreclosure fraud -- the progressive tax code, anti-poverty policy, public investment, public safety, and human and civil rights. We are going to lose these battles-- get used to it. But we need to make an honorable fight, to state clearly what our principles are and to lay down a record which is trustworthy for the future.

..."We are not going to get these things, but we should have a clearly defined program so that people know what they are. And then, frankly, as was said earlier today, said most elegantly by Jeff Madrick, in the long run we need to recognize that the fate of the entire country is at stake. Its governance can't be entrusted indefinitely to incompetents, hacks, and lobbyists. Large countries can and do fail, they have done so in our own time. And the consequences are very grave: drastic declines in services, in living standards, in life expectancies, huge increases in social tension, in repression, and in violence. These are the consequences of following through with crackpot ideas such as those embodied in the Bowles-Simpson deficit commission, as Jeff Madrick again outlined, such notions as putting arbitrary limits on the scale of government, or arbitrary limits on the top tax rate affecting the wealthiest Americans.

This isn't a parlor game. The outcome isn't destined to be alright. It will not necessarily end in progress whatever happens. What we do, how we proceed, and how we effectively resist what is plainly about to happen, matters very greatly for the future of our country, of our children, and of another generation to come. We need to lose our fear, our hesitation, and our unwillingness to face the facts. If we thereby lose some of our hopes, let's remember the dictum of William of Orange that "it is not necessary to hope in order to persevere."

The President should know that, as Lincoln said to the Congress in the dark winter of 1862, he "cannot escape history." And we are heading now into a very dark time, so let's face it with eyes open. And if we must, let's seek leadership that shares our values, fights for our principles, and deserves our trust."

Whose Side Is the White House On?

This is a Democratic forum. When concerned posts are made about the cuts to the social safety net, there are often few responses. More than likely there are many negative responses which seem in denial about these cuts.

In fact today a DUer, jtown1123, posted a link to a group which is starting a no-cuts campaign.

That post has had to be kicked all day long, and it has been mostly ignored. That says a lot about the ease with which we accept that the most vulnerable among us are being harmed by a Democratic administration.

[leftstreet]

1. Healthcare decisions should be made by physicians, not politicians

:grr:

K&R

[patrice]

56. And not by businesses, whether they call themselves faith-based not-for-profits or not . . .

Something people don't realize about not-for-profits is that, just because they don't make a profit, doesn't necessarily mean that they do not PRIMARILY cultivate money.

One of the issues that is at stake in this environment is, once again, what is the definition of Real Value and what are we willing to pay for it. In our "health" "care" machine, I think Real Value should be re-defined as what contributes, and how, to the actual CARE (not tvs, not real estate that care receivers don't use, not decor in places that care receivers never go, not social networking with organizations that do little more than insure vendor contracts that use loss-leaders to sell a bunch of stuff that care givers & receivers don't need . . . ).

http://medicinesocialjustice.blogspot.com/

[tropicanarose]

77. +1 high fives

[Kaleko]

2. It's all coming to a head

and the veils are dropping from tens of millions of people's eyes.

This government is cannibalizing its own workforce. Social genocide under the cloak of "austerity measures."

[area51]

59. +1

Your post should be on the Greatest page. Just the fact alone that we have no right to health care in the U.S. is genocide by omission. This Depression has been allowed to go on for so long, so many jobs are permanently gone, so many people are no longer in the workforce, it will take a new WPA to begin a recovery. It looks like our govt. is trying to cut back on the number of "undesirable" people with policies like this.

[patrice]

3. A CNA at a party that a nurse friend of a friend had told me about a kind of small nursing home,

a not-for-profit nursing home, btw, that he estimated had half-a-dozen non-care-giving employees earning high 5s to low 6 figure incomes.

I wonder who pays those salaries.

[kelly1mm]

10. Do you think with the cuts that those salaries will decrease or that care will be cut? nt

Are those salaries out of line with similar salaries at other nursing homes?

What should the salaries be in your opinion?

[patrice]

48. In today's economy "out of line with similar" doesn't have a high priority with at least me.

How those salaries got to be what they are is partly a result of the 40+ years of systemic inertia since Medicare's initiation + quite a bit longer than that 40+ of systemic inertia acquired by tax-exempt faith-based non-profits in their natural feeding environment: foundation, grants, and other development money (in which milieu, I'm sorry to say, there is a strong probability of de facto or outright Dominionist type relationships with entities such as Chambers of Commerce, a.k.a. vendor contracts).

Have you ever seen a CMS reporting system?

You know, of course, that there ARE all kinds of ways that almost any software can accomplish the same task, e.g. how you can actually BACK a project INTO MS Project Manager, if you know what you're doing.

[patrice]

52. Salaries should be determined by the needs of those receiving care, in order from most direct

care givers to least direct care givers. Period.

Institutional hierarchies NEED to be reversed.

[jwirr]

81. And when the hierarchies do not know how to fill out the forms the

government asks for because they are low pay - low education workers there will be no money to pay for any of the care. I worked as a social worker who did screenings for both the elderly and the for developmentally disabled. These are the papers that gov insisted be perfect and if one item was not correct it came back and the money for that client waited until you straightened out your mess. My daughter is now working on the same thing for a drug treatment center that has not been paid for its clients for 4 months. Fortunately both she and I are experts with paper work. It is not the hospitals etc. that are causing this overhead of non-care workers it is government paper work and insurance paper work. Every time the congress adds another rule or regulation it has to be documented and another worker is eventually needed.

By the way I would not want to take those rules and regulations away in most cases. If you want to know why not then go to the archives here and look at all the post on abuse in these facilities. Most of them are happening because either there are no rules and regulations or some state is not enforcing them.

I was the first to admit that the paper work did not in anyway help the client - but without it there would be no money to help the client. A vicious circle.

[cutlassmama]

4. K&R. this amounts to murder of the elderly. The number of people this

will affect should be made public.

[Brigid]

5. And conditions in nursing homes will get worse and worse.

If such a thing is possible.

BTW, I think the reason this thread isn't getting the attention it deserves is that right now threads about so many issues are crowding it out.

[madfloridian]

9. You may be right....but I fear it is just not an important topic here.

Many people below 50 really do not understand what SS and Medicare are about. Some don't know the difference between Medicare and Medicaid.

Those who do know the importance of the programs think of it in distant views, forgetting that their parents and grandparents will feel the impact. Thus they themselves will be impacted.

Many have no clue how well SS and Medicare have worked because they have no point from which to compare. They have just always been there.

Trust me, if they were suddenly cut drastically or no longer there....they would be changing their lifestyles to accommodate the lives of their parents.

[Tuesday Afternoon]

6. k&r

[patrice]

7. Perhaps those nursing homes will no longer be able to employ Ri$k Manager$, instead of

the nurses and doctors giving the care, to define the level of care that residents will receive.

[madfloridian]

8. Please provide some sourcing for that statement.

I have friends who are social workers and nurses in these wonderful facilities...they work their butts off.

Please indicate which nursing homes/rehab facilities you refer to.

[patrice]

49. We weren't talking about direct care givers. We were talking about people who get between the direct

care givers and those receiving the care.

Please read up on Risk Management. Amongst other things, it has to do with how which facilities decide whom they will take in and whom they won't and why.

[DrunkenBoat]

11. You think a blanket 11% cut is going to fall just on risk managers or people making 6 figures?

If the administration wants to cap administrative salaries, or cut out risk managers, it should do that.

11% cuts will his *care* & staffing. That's the bottom line.

You are like the people who talk about welfare cheats driving cadillacs.

There are probably some, but that isn't the norm, and it's no reason for a blanket 11% cut.

If they want to cut waste & fraud they should *enforce* the laws that already exist & fund enforcement & inspections. They're just cutting everything. It will hit the patients before it hits those making 6 figures.

[madfloridian]

13. "no reason for a blanket 11% cut."

Exactly...and all over the news it is said that it is only going to cut waste and fraud. Waste and fraud are simply buzz words for cutting services to those who need them the most.

[patrice]

46. I said I was wondering where their money comes from. My point is about how much Medicare money pays

directly for, or indirectly makes it possible to pay, people who interfere with direct care giving by the professionals providing the care.

Do you know the answer to this question?

[jwirr]

83. Interfere with direct care - if you mean administrators then I do agree

with you but as a screener for entrance into the nursing homes of today I can tell you that the rules on this are handed right down from the feds. It is part of a program that was instituted years ago that try to keep clients in their own homes as long as possible. Nursing homes today are basically intensive care units and for that reason there are screenings that determine the level of care needed and what placement should be given to the client. The days of going to the nursing homes to retire are long over and home health has replaced a lot of it.

Who exactly are you talking about when you use this phrase - the money crunchers in the hospital administration or screening teams which which include a social worker and a nurse.

[TheKentuckian]

111. Right...here in our reality their use will be ramped up as low paid staff are given

the old "shared sacrifice" routine and the little things that make institutional life tolerable for seniors will be cut away and staffs will be reduced to bare minimum.

In their minds "Risk Managers" save money, they are going nowhere but to higher demand in the present business environment.

These hits will not mostly come out of six figure administrator's asses, profits, the corporate board's cut, or these types of jobs. They will cut wages, activities, staff, services, and the pathetic "thrills" out old people get and we all know it and to pretend otherwise is way beyond Pollyanna.

[Sinistrous]

12. This cut applies to only a small subset of nursing home beds.

As noted in the OP, "The cuts are being made to Medicare reimbursements paid to nursing facilities for seniors receiving post acute care. This care is provided to Medicare recipients recovering from surgery or an illness who require rehabilitative services before retuning home."

I was able find a few more details here:

The cuts are being made to Medicare reimbursements paid to nursing facilities for seniors receiving post acute care. This care is provided to Medicare recipients recovering from surgery or an illness who require rehabilitative services before retuning home.

Hospitals typically discharge seniors as soon as possible to skilled nursing facilities for care in order to reduce costs.

The changes only impact short-term stay residents at nursing facilities. Medicare does not pay for long-term care at nursing homes.

But over the last few years, a growing number of nursing homes have added more rehabilitative services in order to attract more Medicare reimbursed residents.

Medicare pays about $500 a day for short-term stay services, whereas a long-term care resident might only pay about $120 a day.

As noted above, Medicare does NOT pay for long-term care at nursing homes. What assistance is available for long-term care is provided by the states' Medicaid programs, and is restricted to those without any assets whatsoever.

[madfloridian]

14. I did not even mention "long term" care. Of course Medicare does not pay for that.

What made you think that it even matters in this thread.

These seniors who are recuperating are going to lose a lot of care, personnel will be cut.

It is not okay...put lipstick on a pig it is still a pig...and ugly one.

[Sinistrous]

20. It matters because many people do not understand what is being cut

and how it affects the whole population of nursing home residents. There are already a couple of posts above alleging "blanket cuts", which this clearly is not.

It is interesting that nursing home owners and administrators have been actively pursuing Medicare eligible residents because of the generous reimbursement -- and $500/day is very generous. They see it as a cash cow to plump up their bottom line. And my observation is that it is the "for profit" homes that really push their "rehabilitation" services. Those residents receiving rehabilitative care (not all of whom are elderly, btw) will (or should) still get excellent care from a home being reimbursed $455/day as they would at $500/day.

The hand wringing and apocalyptic forecasts by the facility owners is self-serving poppycock.

[madfloridian]

35. Your post is so very cold and sounds thoughtless.

I am not sure how to even discuss with someone who says: "The hand wringing and apocalyptic forecasts by the facility owners is self-serving poppycock."

Did you read the first sentence in the article?

"The nursing home industry suffered a startling setback July 29 when the federal government announced that Medicare rates will be slashed by 11.1% starting Oct. 1."

And further down:

"The cuts are being made to Medicare reimbursements paid to nursing facilities for seniors receiving post acute care. This care is provided to Medicare recipients recovering from surgery or an illness who require rehabilitative services before retuning home."

Those surely sound like "blanket" cuts to me.

Looks like it will severely impact those who go there to receive therapy....which BTW is a life-saving service which gives the patients a dignity.

There is no long-term with Medicare, so it will impact short term.

Sounds pretty across the board to me.

But I expected such remarks here, it is getting more common.

I say stop the tax cuts for billionaires before you cut vital life-saving services to seniors.

Oh, yeh, did I forget? Medicare cuts will also impact home health care groups severely

[Name removed]

88. Deleted message

Message removed by moderator. Click here to review the message board rules.

[madfloridian]

89. I resent your accusation I am starting a "fear fire"... Prove I am wrong.

Or stop saying insulting things.

This is very serious stuff, and the article is very clear.

If the article is wrong, then prove it wrong.

[loyalsister]

100. Nursing homes are corporate welfare

With their own huge lobby.

http://www.mcknights.com/nursing-home-lobby-launches-multimillion-dollar-ad-campaign/article/210823/

The current state of health care has a lot to do with our history of locking people away in nursing homes. People are not fighting to get into them.

[DrunkenBoat]

18. That information is in the OP already.

This care is provided to Medicare recipients recovering from surgery or an illness who require rehabilitative services before retuning home.


And it's not a small subset of patients.

"Hospitals discharge patients as quickly as possible" -- yes, in many cases with iv lines, tpn & chemo ports, all sorts of things that are very difficult for some people to manage at home. Especially elderly spouses.

It's disgusting. People will die.

[madfloridian]

19. Indeed they will.

Many have no one at home to care for them. Rehab care is absolutely necessary.

[Sinistrous]

22. Sorry, it is a small subset of the whole population of nursing home residents.

And where did the specter of discharging to home care come from? This cut applies only to persons in nursing homes.

[DrunkenBoat]

24. Because if the hospital d/cs them & if they can't get nh care, they will go home.

And home health care has also been cut.

And 30% of nursing home funding comes from Medicare.

http://smallcapworld.wordpress.com/tag/rehabilitation-care-facilities/

[Sinistrous]

26. Yep. Your concern/argument is truly a specter.

To clarify, I was referring to care-in-the-home, not professional home health care.

[DrunkenBoat]

27. So was I. And my concerns are no spectre. It already happens; I've witnessed it

in my work & in my family.

If there's no professional care, it's the family doing the home care. In many cases it's an elderly spouse with memory & stamina issues. An elderly family member of mine literally died from it. The care (for a spouse with ALS) included toileting, bathing, bolus feedings through a tube, cleaning of the tube, and injections. The spouse could no longer speak or swallow & had limited mobility. He was "instructed" on how to do these things by home health aides who came once a week. He exhausted himself trying to do the right thing & died of a heart attack.

In many other cases, there's no one.

In other cases, children who are already working/caring for children do care in shifts. I have done this. It is debilitating when you are also working a 40 hour week.

Blanket cuts in a needed service do *nothing* to stop fraud & waste. Nothing. Particularly as in many cases the people perpetuating the waste & fraud are in administration. They will cut services before they'll get off their personal gravy train.

Enforcement is wanting. It's not happening.

[Sinistrous]

31. I really do understand the hardships in providing total care.

I have been there also, and it is exhausting.

[DrunkenBoat]

32. I hope you would then also understand that cutting 11% from rehabilitative

care will indeed affect that picture.

Particularly with cuts already in place or coming in home health & medical reimbursements, as well as state Medicaid.

[Name removed]

25. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Sinistrous]

28. I see you did not grasp that the statement that so offends you

was made to point out the distinction between care in the home and care in a nursing home.

Your characterization of that excerpt as "psychopathic" is ludicrous.

[Name removed]

29. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Sinistrous]

30. "Lacking human empathy" isn't in there either.

Maybe when your rage has cooled, you will be able to read what I really said.

[Name removed]

33. Deleted message

Message removed by moderator. Click here to review the message board rules.

[madfloridian]

41. I read your words. They show little empathy.

[Sinistrous]

87. Does one need to always commiserate?

I was merely stating facts. Sometimes they may seem "lacking empathy", but such is the nature of the beast.

[madfloridian]

39. They are cutting home health care as well.

http://journals.democraticunderground.com/madfloridian/8073

[madfloridian]

40. "The changes only impact short-term stay residents at nursing facilities"

And that is okay?

[eilen]

93. Cost cutting in snfs with rehabs for subacute patients

usually results in higher readmission rates at the hospital. One if the first things they have cut is the food. We just had an elderly woman sent back to the hospital with CHF exacerbation because of the high sodium foods they gave her. She gained 12 lbs in 2 weeks. The family had requested low sodium, told them she was not supposed to give her salty foods. They also complained that they were not weighing her everyday-- btw, these items were discharge instructions ordered by the Dr. When she was in the hospital, she did not have any lower extremity edema, but she returned with it.

In Jan. Medicare will no longer compensate hospitals for patients with CHF who have been readmitted within 30 days (as well as some other diagnosis). We are working really hard on teaching positive self care behaviors to prevent this but how can we do this when the nursing home facilities don't even follow it? I feel we should send them the bill for this new hospitalization, esp. since it will likely be for 7 days, on telemetry. In fact, I had recommended to her family that at the follow-up Dr. visit (which never happened since she came back to the hospital beforehand) to ask for an order for home care and get out of the nursing home so they can control the food and get her weighed every day.

This trend in cuts is very bad and will have many unintended consequences. The reason why nursing homes should be paid much more for subacute rehab is because those patients require more services than the average long term care resident. They get 2 or more physical therapy sessions a day, full baths, are monitored much more closely by nursing, dressing changes, they have more complicated medications and are often full code status necessitating more licensed people on the floor. Nursing homes are also very highly regulated, more so than the nuclear industry. Those three week rehab stays often go home with homecare services.

[Overseas]

44. It is a very important subset of services. Especially for seniors who live alone.

If we had single payer, hospitals might not need to discharge patients so soon after surgery. But since healthcare is a privatized, profit focused enterprise, we need the transitional beds for post acute care.

These services were very important to my friend after her knee replacement surgeries.

It is really depressing that my country would cut the budget for these services because they were too reluctant to let tax cuts for the super rich expire on schedule.

[madfloridian]

15. There is no defense for cuts like this in a Democratic administration.

I have been amazed at how many will just keep defending the cuts that will harm elderly and disabled.

It should no longer surprise me, but it does.

[Sinistrous]

23. Where did who defend this cut?

Or do you have trouble with facts?

[madfloridian]

36. You are defending them.

You are saying things that indicate there is little caring about people.

[Sinistrous]

85. Explaining them. Not defending.

There is a difference.

Maybe if you got out of the "Me versus you" mentality, you could see more clearly.

[999998th word]

34. Repub's are responsible-it's indefensible, and I will still vote 4 Obama

The very worst we can do with giving President Obama another 4 years is buy ourselves time. People are finding out more and more.

We must have it to take back our state houses etc...THATS where its important. It won't get better if we primary the President. Why hand it to the

RW's, they would LOVE to see that. Some of the Dems are also responsible as well, overall don't buy into their game of divide and conquer.

You're right, more people should take notice of the erosion in the safety net and also the way they are 'handling' this manufactured financial crisis'.

Believe me the majority of those who are not paying attention to this, or worse yet the ones who AGREE with this horseshit will be gobsmacked when it affects them, and it will.

In the future, their parents/grandparents will need care-where, and how will they get it?

[madfloridian]

37. Obama is president. He is not fighting such cuts.

In fact he put them on the table.

[WinkyDink]

75. I was going to say, "Not fighting?! He's an advocate!"

[eilen]

94. Someone break a light bulb, there's more crack to smoke

Hello, he proposed the cuts.

[Fuddnik]

16. Here, have a cup of Kool-Aid. You'll fell much better.

They'd probably cut it 12% under a Perry or Palin Administration!

Just click your heels together three times and say "I wish I was in Kansas again", and it will all go away.

Welcome to fascist Amerika.

[madfloridian]

17. Heh heh

I drank enough of that through the years. But when they start messing with SS and Medicare...even the kool-aid doesn't work. I'm done with kool-aid. :)

[bananas]

21. Seniors Group Launches Multi-Million "No Cuts" Campaign for Social Security, Medicare & Medicaid

For anyone who didn't read all the way to the last link in your post: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=439&topic_id=1978115&mesg_id=1983325

[madfloridian]

43. Thanks, that link needs a lot of attention.

:hi:

[William769]

38. K&R.

[madfloridian]

42. General consensus here is that these cuts are fine. I am not surprised.

It's becoming less and less of a shock to see that this administration's attitude toward seniors and teachers is acceptable. I guess it is a necessity if one does not want disagreement or questioning.

It's a dangerous path to take, the no questioning route. The GOP did that kind of thing with Bush, kept accepting and saying ok.

But at least our party leaders fought Bush when he went after education and social safety nets. Now we don't.

[madfloridian]

45. By 2017 you will pay a penalty for buying a medi-gap plan? Over treatment??

I have read this several times, and it still makes no sense.

"Newly signed-up beneficiaries would pay a penalty if they also purchase private insurance that covers all or most of Medicare's copayments and deductibles. Administration officials say such insurance encourages over-treatment."

Read more: http://www.time.com/time/nation/article/0,8599,2094023,00.html#ixzz1YgtIBIVF

[Hell Hath No Fury]

69. Wahhh?????

That does not make sense to me. My Mom pays for Medigap insurance that covers everything that Medicare does not -- without it, she would be bankrupted by her medical bills. :wow:

That is unfuckingbelievable -- I had no idea that was stuck in there. There should be outrage over this -- seniors who face multiple health issues would face disaster if not for full coverage. :mad:

[madfloridian]

70. Pretty weird, huh? Makes no sense.

That really needs its own thread.

[Moosepoop]

80. Only the really high-dollar ones.

Most Medigap policies would be exempt. The very costly ones would incur a surcharge on the Part B premium roughly equivalent to 15% of the average Medigap policy premium.

[eilen]

95. That is an equivication and apologist response

Why don't you ask those that need those policies how necessary they are?

[Moosepoop]

109. I did not equivocate or apologize.

I gave a factual response. Why don't you comment on the factual response posted, instead of engaging in a personal attack? You could start with what part of my post was not factual?

[999998th word]

103. Encourage over treatment?? WTF ? Who wants to spend

more time at the effing doctors office than they HAVE TO ? Do they think-once people finally do get some 'health insurance' they will abuse it, have the urge to go

to the doctors office all of the time-kind of go on a health care 'spending spree'??

The same RW stinktanks that brought us the 'you're not poor if you own a flatscreen TV, microwave, cellphone, or an AC' bullshit.

Thanks for the updates, and we need time to let more people know-thats why I will still vote Democratic in '12. It will at least slow it down.

You're right all of this is horrifying.The most dangerous thing-to me-is the voter disenfranchising bills. Once that is gone, they will be in, and we will NEVER get it back.

[durablend]

47. Nothing to see here, folks...

Accept it or else you're admitting you're a racist, hate America and secretly want Palin/Perry/Romney in office.

:sarcasm:

[patrice]

50. . . . or people might consider finding out a little more about the nuts-&-bolts of care giving. nt

[madfloridian]

53. OR..some need to learn about the "nuts-&-bolts" of the elderly and disabled.

And some need to see that those among the most vulnerable in our society are being cut 11.1%.

There is no excuse for this while the very rich suffer no pain at all.

Caregiving costs money.

[patrice]

65. Indeed caregiving costs money. But why are we assuming that everyone defines caregiving the same way

especially those managing those $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$.

Is it possible that those doing the DIRECT care have a definition for caregiving that is different from the (BUSINESS) institutions'?

Have you ever seen a CMS reporting system?

Have you ever been around a "health" "care" resource CMS survey?

[madfloridian]

67. Nothing you say justifies cutting payments for vital services across the board.

I am sorry, but your argument falls on my deaf ears.

[TBF]

57. Why don't you explain that to us oh wise one?

Tell us about how wonderful Mr. Obama is for making these cuts. And while you're at it, why don't you admit who he's really serving here?

[patrice]

64. No, you tell me instead why Physicians for a National Health Program SUPPORT an annual review of ALL

PAYMENTS as defined, and co-signed by 65 Representatives, in Rep. John Conyers' HR 676 Expanded and Improved Medicare for all Title II Sub-section A.

[TBF]

72. You didn't answer my question. Nothing new. nt

[Vinca]

51. It really shows what kind of society we've become when the most vulnerable

among us are targets. It's not just the patients, either. It's the nursing assistants, janitors, cooks and other people who are generally paid too little to begin with who will take the hit.

[madfloridian]

54. It is infuriating to see these cuts defended at a Democratic forum.

I get sick inside to see it, just like I do when the attacks on teachers are defended here.

It's like I am losing faith in a party I trusted forever.

[999998th word]

104. Makes me sick too-and who, other than a RW olltray would

attack teachers, for god sake. These things are all the basic tenets of the Democratic party, and need defending-and we need the time to do so, the media wont do it.

The amount of misinformation that is spewed by the RW in these forums, and elsewhere is appalling and needs to be squelched,

[patrice]

55. BTW, All, I have also seen my Mother and my MIL off into the hereafter, in timeframes that

totaled at least 15 years of experience with various nursing homes and hospitals.

Please look for databases of actual experiences in these milieu. I'm pretty sure they are out there, because my and my family's experiences are not unique.

"Health" "care" in this country is a machine.

[madfloridian]

58. So you are saying you are okay with the Medicare payment cuts?

I am a little confused about your point.

[patrice]

63. I'm saying I have seen "health" "care" resources paid for lousy "care". I am saying it's a VERY

complex system full of multiple types of payees with their fingers in the pie.

I'm saying that it is very interesting to me that Physicians for a National Health Program features Rep. John Conyers' HR 676 Expanded and Improved Medicare for All on it's front page and in Title II in that bill, with 65 Co-signers, we see one of the first recommendations is an ANNUAL REVIEW of ALL PAYMENTS and, therein, the different kinds of payments are listed, including things such as real estate for example (??? real estate, perhaps, for expansion of facilities that are already too big to manage effectively anyway and thus provide all kinds of opportunities for hiding less than effective, in terms of CARE, payments . . . ?).

I'm just saying that there is this bad habit of people screaming and boosting (ANONYMOUS) generalities without bothering to find out down at the lowest level possible, with actual suffering persons and actual Medicare experiences, what they are SPECIFICALLY talking about in the context in which it occurs. There are many questions not only about this, but about everything else also, that toooooo many people want to pretend just aren't there in order to get that sweet buzzzzzzzzzzzz going for themselves and whatever it is that they think they are doing, without any regard for people like my MIL, in particular, who don't benefit one god damn bit from un-informed threads on the internet with their thread-icon flaming and all kinds of people getting-it-on in there and affirming stuff that many of them have very little actual direct knowledge of, or what knowledge they do have is evaluated from rather selective assumptions. I think this problem is seen in practically every issue you see on this board and elsewhere. Relatively un-informed, and, yes, in SOME instances, even ignorant, pressure built up around buzzzzzzzzy generalities is what has ENSLAVED America and HURTS ALL KINDS OF PEOPLE EVERYWHERE.

[madfloridian]

68. I hope you do NOT include me in this group of "relatively un-informed"

You said:

"I think this problem is seen in practically every issue you see on this board and elsewhere. Relatively un-informed, and, yes, in SOME instances, even ignorant, pressure built up around buzzzzzzzzy generalities is what has ENSLAVED America and HURTS ALL KINDS OF PEOPLE EVERYWHERE."

Not every issue you see on this board is that way at all.

[patrice]

66. on edit: "Health" "care" in this country is a MONEY machine. nt

[TBF]

Well that's true - but the answer is not to make wild cuts.

We should nationalize it and take the profit out.

[999998th word]

105. Single payer.P.E.R.I.O.D..

[TBF]

107. Yup, that's what I'm saying. nt

[Bandit]

60. Is this a part of the five hundred billion in cuts to Medicare in the Health Care Bill?

The five hundred billion in Medicare cuts that the Republicans railed against during the national debate over Health care. They went on and on how they wanted to "save" Medicare and Democrats wanted to destroy it.....Anyone else here remember that far back?

[dgibby]

61. As a retired RN,

I can attest to the damage this is going to do to seniors. Thanks for continuing to fight the good fight, Madflo.

[Carolina]

62. K&R!!!

And so it begins...

Kicking this so it gets a boost in the thread column.

[Maraya1969]

71. I really am shocked. I never thought it was actually going to happen.

I know money in the state of FL was being taken away from the disabled and other state provisions were being taken away but I never thought a federal cut would go through. When the Hell did this happen? What bill?

[madfloridian]

76. I gather it is the CMS doing it all by their lonesome. Quicker that way.

And it slips by unnoticed. This paragraph indicates that..

"When the Centers for Medicare and Medicaid services announced it was cutting Medicare rates by 11.1% starting Oct. 1, many in the industry were stunned, reports National Real Estate Investor."

http://seniorhousingnews.com/2011/09/01/cms-medicare-payment-cuts-will-force-nursing-homes-to-reduce-staff/

They have been cutting Medicare for a while, we just haven't noticed.

[WinkyDink]

73. Yep. And a $100 fee on Home Visits is apparently being considered. Get yer ice floe heah!

[bobthedrummer]

74. K&R n/t

[jwirr]

78. There is no savings here. The patients will just be kept in the hospital

at a higher cost. The people who are making these cuts do not seem to understand the funding mechanisms that apply. People who are having surgery or some other procedure are now moved to a nursing home as soon as they can be because the nursing home is cheaper. So they cut the care in the nursing home and the doctors will keep them in the hospital where they can get the kind of care they need.

Most of our nursing homes today are intensive care units and the type of care a patient receives is vital to his/her survival.

Just another "die quickly" measure.

[louslobbs]

79. Kicked and Rec'd

Lou

[KT2000]

82. This is a death panel

repub version anyway. Hospitals will continue to release patients who need acute care but where they will go will depend upon their ability to pay. That in turn will affect the level of care that person will receive and likely whether or not they will suffer complications and/or death.

This looks to me like someone's solution to the high cost of end of life care.

An uninsured young man was hospitalized in our local hospital with a MRSA infection on his leg. He did not receive surgery due to the fact that he had no insurance. He was sent home with antibiotic wipes. Of course the infection flared again and he was back in the hospital.

An elderly woman up the street drove off a cliff in her car. The hospital released her that night to be cared for by her husband who had advanced dementia.

This is how it is done in the real world.

[Capitalocracy]

84. But don't worry! That's not a cut to "Medicare recipients"

Cuts to the service providers don't affect the recipients in Geithnerland!

[Hoyt]

86. Appears vested nursing home industry is whining about something that is not as bad as they make it.

As the article at the link below indicates. nursing homes will simply be reimbursed differently for physical, occupational and speech therapy. In October, nursing homes will be paid less when one therapist is treating two patients (using the basically the same methodology as they get paid now for group therapy involving 3 or more patients).

I don't see that as big a threat as the vested nursing home industry is making it.

According to the article below, "Even with the reduction, CMS noted, Medicare payments to nursing homes will be 3.4 percent higher in the 2012 fiscal year than they were in 2010." Of course, some of that might be increased beneficiaries.

http://www.ctmirror.org/story/13487/nursing-home-medicare-cut

If it really affects patient care, we'll know it pretty quickly and the government should respond accordingly to sanction the homes that take it out on patients so they can continue funneling "profits" to execs and/or owners.

I really do not believe the government would cut payments for this therapy if they thought it would impede the patient being discharged home. Every day the patient spends in a nursing home costs far more than the small amount this change will make. Plus, most patients will be far happier at home.

[man4allcats]

90. This STINKS!

I've known people in nursing homes. It was always bad enough. But THIS! THIS JUST STINKS LIKE SHIT!!!

[Admiral Loinpresser]

91. How's that 3D chess workin' out for ya? n/t

n/t

[Jakes Progress]

92. Why should the administration worry about this?

It's just about a bunch of old people. And it's not like they will need to worry about it for themselves. So in all, it's just about unwealthy, old people. See. No reason to care.

[secondwind]

96. Nursing homes abuse the system. Medicare is fraught with waste and abuse. It's about time

something was done about this.

[madfloridian]

99. That remark...

just earned you a big loud good bye from me.

[TBF]

108. Any evidence on that or just repeating FAUX talking points? nt

[KamaAina]

97. Could be a blessing in disguise, if the Administration would embrace home- and community-based care

which has been shown time and time again to be cheaper than institutional care, as well as far less soul-sucking.

There's already a program in place, called Money Follows the Person (that is, the same funds are spent whether the recipient is in an institution or at home), but so far it's a drop in the bucket.

[madfloridian]

98. There are planned deep cuts there as well, unfortunately.

Medicare Cuts Will Cripple Home Health Agencies says Report

"..."Large adjustments to home health payments will have a significant and alarming impact on the financial viability of home health providers, says NAHC, which could threaten access to a system of care that many seniors prefer.

CMS contended in its proposal that the adjustment was warranted because there has been limited change in patient acuity in the past few years, but NAHC countered by saying there is strong evidence showing patients to be sicker than ever and in need of the extensive care that has made care costs rise significantly.

"“Federal regulators have made assumptions regarding our patient population and patient acuity that do not accurately reflect the reality of home health care in America. As a result, their proposed payment adjustment is dangerously speculative and risks denying Medicare beneficiaries the care they need,” said Andrea Devoti, NAHC board chairwoman, in a statement."

[loyalsister]

101. + 1

And then there's this:
The Olmstead Act has yet to be fully enforced. There are many people in nursing homes who do not want to be there.

http://www.accessiblesociety.org/topics/ada/olmsteadoverview.htm

[DollyM]

102. I got my hours cut simply because the state was so far behind on payments to the NH

I was working part time as an activity assistant at a 99 bed nursing home. I loved my job but when they cut me to 10 hours a week because the state was 6 months behind in making the payments to the home, I went looking for something else. Now I am totally unemployed and was hoping to get back on at a nursing home. I doubt if they will be hiring anything "fluffy" now like in the Activities department. Cuts in money to the nursing home also means cuts in jobs and services which is a vicious circle.

[999998th word]

106. Sorry to hear that, I was a CNA for years and

those who don't have their hours cut will be dangerously overworked. That is wrong on many levels, unsafe working conditions . The temptation to cut corners w/care exists

in that environment.If you don't comply, & insist your residents get proper cares you are considered a 'whistleblower' management will get rid of you somehow. In my case the pretext was a WC injury.

That was 'gamed' by them as well. Never having made a claim I was naive enough to think that system worked-NOT. As an older worker-I am out-and after years of working @ jobs, now disabled and

finally had to go on SSDI. Thank god for that.

[ellisonz]

110. This is an incomplete analysis of the nursing home aspect and I suspect the home care too:

Nursing Homes' Lost Lobbying Fight to Cost Industry $3.87 Billion in 2012
Q
By Drew Armstrong - Jul 29, 2011 9:01 PM PT

U.S. nursing homes’ lost lobbying battle with Medicare will cost the industry $3.87 billion, as the health program tries to recover overpayments it says it made to companies such as Kindred Healthcare Inc. (KND) and Sun Healthcare Group Inc. (SUNH)

The 11.1 percent Medicare rate cut for next year is meant to stop overbilling by for-profit homes including Sun, Kindred, and Skilled Healthcare Group Inc. (SKH) The change follows Medicare’s finding that, under a new payment system put in place this year, the companies drove up reimbursements for patients.

The new rates “correct for an unintended spike in payment levels and better align Medicare payments with costs,” according to a statement by Medicare, the U.S. health plan for the elderly and disabled. The American Health Care Association, the industry’s Washington lobby group, said Medicare is moving too fast, and that the sudden cuts won’t give nursing homes time to adjust.

---------

To stop the cuts, or at least make them smaller, nursing homes lobbied Medicare regulators and Congress. Acknowledging the industry was overpaid, the American Health Care Association urged Medicare put off the cuts and wait to collect more data.

http://www.bloomberg.com/news/2011-07-30/nursing-homes-...

So basically for-profit nursing homes over-billed the federal government and to support other programs the reduction is being made. Having personally been part of Medicare fraud in a nursing home I can tell you that it is rampant. It could be as much as $50 billion. So really the fact is that the corporate nursing homes don't want to reduce their profit margin and keep bilking the taxpayers. I think the solution is more reform.

http://en.wikipedia.org/wiki/Medicare_fraud

[avaistheone1]

112. This truly sucks big-time.

F*** all the people responsible for this.