Extremely important messages here. Most of Europe and Eastern Asia clearly wonders whether the US has any backbone or integrity. Most African nations gave up on us long ago ( or perhaps always knew better). We cannot survive as Fortress America. The only congratulation I have ever sent to Sen Ernst was for her support of the most recent Ukraine funding. So sad that our Senators are so late in, for once, opposing The Isolationist/Insurrectionist hard-line.
Yes! What message is the U.S. sending to the rest of the world with this dysfunction so visibly displayed? Unreliable global partner and ally? A nation in decline, unable to follow through on its commitments? Thank you!
Yes, Cheryl, following up. The Republican party's big mouthpiece recently called for Putin to attack those European nations who don't pony up enough for defense. This is traitorous rhetoric. If you or I were to express such sentiments, we would be raked over the coals. But the Republicans in Iowa are silent. It is frightening, appalling. They seem to want China to attack Taiwan, and Russia to prevail in Ukraine. Incredible! Sorry if I'm acting a bit deranged and angry, but we could have this idiot as a President in a short ten months.
In the first paragraph under the heading “On the Ground in Poland” there is an error. You state that Russia invaded Bohemia and Moravia in October, 1938. It was Germany.
MY LATEST, submitted to the Register, the Gazette and the Storm Lake Times
Here's something to celebrate, something to ponder, and something to do something about:
Thankfully, the President of the United States made improving nursing home care an Administration priority. During his State of the Union Address, President Joe Biden actually spoke about the longstanding, studied, obvious need to substantially improve care to more than1.3 million nursing home residents. Representing 2.3% of the elderly population, they are our grandparents, our parents, our siblings, our neighbors, and our friends. One day, "they" will be "us".
Residents are entitled to, and deserve so much more care than they are provided. It is long overdue to prioritize the most fundamental, the most basic, the most impactful changes that are long known and understood by everyone to protect and enhance residents' lives. Of course, every resident, or nearly every resident, will immediately tell you (assuming they don't fear retribution) that staffing levels are grossly inadequate (b/t/w, who thinks weekends don't require the same staffing levels as weekdays, what's different?).
The current standard, enough staff to meet care needs, is a researched, well known failure. Staff turnover is over 60%, pay is exceedingly low, staff are undervalued, and, if that wasn't enough, they are scapegoated for harms caused by owners' prioritizing profits over care. This mostly For-Profit industry is made up of investors and equity interests, including so called "related parties" who siphon off cash to make it appear as if the nursing home is losing money. Lack of transparency in where the 100's of billions of taxpayer dollars are actually going is a monumental problem. But, that's an expose' for another day, and the nursing home industry would prefer to keep that quiet.
The Centers for Medicare & Medicaid Services (CMS) is responsible for correcting the staffing failure, and, as a direct consequence, its harmful resident outcomes. CMS is looking to finalize its "minimum staffing proposal" in 2024. Its original proposal garnered over 46,000 comments, with the powerful industry, as anticipated, selling horrific consequences (scare tactics) if the proposal is adopted. As expected, aligned politicians (Republicans) (campaign donation beneficiaries-https://iowacapitaldispatch.com/2023/12/22/nursing-homes-invest-in-campaigns-reap-millions-in-taxpayer-money/?emci=0050d5b2-dca8-ee11-bea1-002248221f54&emdi=28c1bf73-66a9-ee11-bea1-0022482237da&ceid=77947) have jumped into the fray, promising to reverse, even if not significantly improved in its final form, CMS' modest, arguably inadequate, proposal.
Notably, more than two decades ago, a study commissioned by CMS found that 4.1 hours of care per resident day (HPRD) was necessary to support quality care, including 0.75 RN hours, 0.55 LPN/LVN hours, and 2.8 CNA hours. Unfortunately, CMS' proposed rule only puts forward two occupation-specific standards—0.55 RN hours and 2.45 CNA hours, with no requirements for LPNs/LVNs. As to any additional cost (without taking account of significant cost savings by reducing caregiver turnover, saved litigation expense, etc.), the increase would be less than five percent of the over $100 billion that nursing homes receive from Medicare and Medicaid (taxpayers) annually.
In addition to eliminating the nursing home industry's bleeding profits away from staffing, I have another idea that could make a dent in any additional staffing expense. The American Health Care Association (AHCA) is one of the national "Not for Profit" groups that represents its member nursing homes. It is a tremendously powerful lobbying organization with two objectives: 1. more government (taxpayer) funding and 2. less government oversight.
Here's a thought. AHCA's 2022 Form 990 tax return (https://projects.propublica.org/nonprofits/organizations/530260105/202313179349305746/full) notes "Membership Dues" revenue in the amount of $23,964,439. Maybe the AHCA's President & CEO, Ex-Kansas Governor Mark Parkinson, who lists $2,323,234 in compensation, would be willing to redirect some or all of AHCA's taxpayer funded Membership Dues to staffing. Or, maybe our elected officials, with greased palms from the industry, could forbid, instead of allow, taxpayer dollars funding the AHCA.
The AHCA has done everything in its power to either prohibit or restrict CMS' proposed staffing mandate, and we taxpayers paid Mr. Parkinson and his overpaid cadre of lobbyists to defeat or lessen the requirements that would protect our seniors from harm.
Extremely important messages here. Most of Europe and Eastern Asia clearly wonders whether the US has any backbone or integrity. Most African nations gave up on us long ago ( or perhaps always knew better). We cannot survive as Fortress America. The only congratulation I have ever sent to Sen Ernst was for her support of the most recent Ukraine funding. So sad that our Senators are so late in, for once, opposing The Isolationist/Insurrectionist hard-line.
Yes! What message is the U.S. sending to the rest of the world with this dysfunction so visibly displayed? Unreliable global partner and ally? A nation in decline, unable to follow through on its commitments? Thank you!
Yes, Cheryl, following up. The Republican party's big mouthpiece recently called for Putin to attack those European nations who don't pony up enough for defense. This is traitorous rhetoric. If you or I were to express such sentiments, we would be raked over the coals. But the Republicans in Iowa are silent. It is frightening, appalling. They seem to want China to attack Taiwan, and Russia to prevail in Ukraine. Incredible! Sorry if I'm acting a bit deranged and angry, but we could have this idiot as a President in a short ten months.
Well done.
Thanks, Char!
In the first paragraph under the heading “On the Ground in Poland” there is an error. You state that Russia invaded Bohemia and Moravia in October, 1938. It was Germany.
Ah, thanks so much for letting me know. Of course, I knew this, but misspoke. Thanks again!
excellent
Brilliantly written, terrifying reality!
Thank you, Dean. I love such encouraging feedback!
MY LATEST, submitted to the Register, the Gazette and the Storm Lake Times
Here's something to celebrate, something to ponder, and something to do something about:
Thankfully, the President of the United States made improving nursing home care an Administration priority. During his State of the Union Address, President Joe Biden actually spoke about the longstanding, studied, obvious need to substantially improve care to more than1.3 million nursing home residents. Representing 2.3% of the elderly population, they are our grandparents, our parents, our siblings, our neighbors, and our friends. One day, "they" will be "us".
Residents are entitled to, and deserve so much more care than they are provided. It is long overdue to prioritize the most fundamental, the most basic, the most impactful changes that are long known and understood by everyone to protect and enhance residents' lives. Of course, every resident, or nearly every resident, will immediately tell you (assuming they don't fear retribution) that staffing levels are grossly inadequate (b/t/w, who thinks weekends don't require the same staffing levels as weekdays, what's different?).
The current standard, enough staff to meet care needs, is a researched, well known failure. Staff turnover is over 60%, pay is exceedingly low, staff are undervalued, and, if that wasn't enough, they are scapegoated for harms caused by owners' prioritizing profits over care. This mostly For-Profit industry is made up of investors and equity interests, including so called "related parties" who siphon off cash to make it appear as if the nursing home is losing money. Lack of transparency in where the 100's of billions of taxpayer dollars are actually going is a monumental problem. But, that's an expose' for another day, and the nursing home industry would prefer to keep that quiet.
The Centers for Medicare & Medicaid Services (CMS) is responsible for correcting the staffing failure, and, as a direct consequence, its harmful resident outcomes. CMS is looking to finalize its "minimum staffing proposal" in 2024. Its original proposal garnered over 46,000 comments, with the powerful industry, as anticipated, selling horrific consequences (scare tactics) if the proposal is adopted. As expected, aligned politicians (Republicans) (campaign donation beneficiaries-https://iowacapitaldispatch.com/2023/12/22/nursing-homes-invest-in-campaigns-reap-millions-in-taxpayer-money/?emci=0050d5b2-dca8-ee11-bea1-002248221f54&emdi=28c1bf73-66a9-ee11-bea1-0022482237da&ceid=77947) have jumped into the fray, promising to reverse, even if not significantly improved in its final form, CMS' modest, arguably inadequate, proposal.
Notably, more than two decades ago, a study commissioned by CMS found that 4.1 hours of care per resident day (HPRD) was necessary to support quality care, including 0.75 RN hours, 0.55 LPN/LVN hours, and 2.8 CNA hours. Unfortunately, CMS' proposed rule only puts forward two occupation-specific standards—0.55 RN hours and 2.45 CNA hours, with no requirements for LPNs/LVNs. As to any additional cost (without taking account of significant cost savings by reducing caregiver turnover, saved litigation expense, etc.), the increase would be less than five percent of the over $100 billion that nursing homes receive from Medicare and Medicaid (taxpayers) annually.
In addition to eliminating the nursing home industry's bleeding profits away from staffing, I have another idea that could make a dent in any additional staffing expense. The American Health Care Association (AHCA) is one of the national "Not for Profit" groups that represents its member nursing homes. It is a tremendously powerful lobbying organization with two objectives: 1. more government (taxpayer) funding and 2. less government oversight.
Here's a thought. AHCA's 2022 Form 990 tax return (https://projects.propublica.org/nonprofits/organizations/530260105/202313179349305746/full) notes "Membership Dues" revenue in the amount of $23,964,439. Maybe the AHCA's President & CEO, Ex-Kansas Governor Mark Parkinson, who lists $2,323,234 in compensation, would be willing to redirect some or all of AHCA's taxpayer funded Membership Dues to staffing. Or, maybe our elected officials, with greased palms from the industry, could forbid, instead of allow, taxpayer dollars funding the AHCA.
The AHCA has done everything in its power to either prohibit or restrict CMS' proposed staffing mandate, and we taxpayers paid Mr. Parkinson and his overpaid cadre of lobbyists to defeat or lessen the requirements that would protect our seniors from harm.
That's a real head-scratcher!
Thanks, Dean. I'll look for this, and learn from it, too. Thanks for your advocacy on this critical issue.
Great post!
Thanks, John!