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Study undermines Biden administration promise to boost nursing home staffing

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lailluminator.com – Jordan Rau, KFF Health News – 2023-09-03 05:00:32

Study undermines Biden administration promise to boost nursing home staffing

by Jordan Rau, KFF Health News, Louisiana Illuminator
September 3, 2023

The Biden administration last year promised to establish minimum staffing levels for the nation's roughly 15,000 nursing homes. It was the centerpiece of an agenda to overhaul an industry the government said was rife with substandard care and failures to follow federal quality rules.

Instead, the new study said there was no single staffing level that would guarantee quality care, although the report estimated that higher staffing levels would lead to fewer hospitalizations and emergency room visits, faster care, and fewer failures to provide care.

Patient advocates said the report was the latest sign that the administration would fall short of its pledge to establish robust staffing levels to protect the 1.2 million Americans in skilled nursing facilities. Already, the administration is six months behind its self-imposed deadline of February to propose new rules. Those proposals, which have not been released, have been under evaluation since May by the Office of Management and Budget. The study, dated June 2023, has not been formally released either, but a copy was posted on the CMS website. It was taken down shortly after KFF Health News published this article.

“It's honestly heartbreaking,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for nursing home patients in New York state. “I just don't see how this doesn't ultimately put more residents at risk of neglect and abuse. Putting the government's imprimatur on a standard that is patently unsafe is going to make it much more difficult for surveyors to hold facilities accountable for the harm caused by understaffing nursing homes.”

For months, the nursing home industry has been lobbying strenuously against a uniform ratio of patients to nurses and aides. “What is clear as you look across the country is every nursing home is unique and a one-size-fits-all approach does not work,” said Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association, an industry trade group.

Over a dozen nursing homes could evacuate to facilities that failed state inspections

Nursing home groups have emphasized the widespread difficulty in finding workers willing to fill existing certified nursing assistant jobs, which are often grueling and pay less than what workers can make at retail stores. Homes say their licensed nurses are often drawn away by other jobs, such as better-paying hospital positions. “The workforce challenges are real,” said Katie Smith Sloan, president and CEO of LeadingAge, an association that represents nonprofit nursing homes.

The industry has also argued that if the government wants it to hire more workers it needs to increase the payments it makes through state Medicaid programs, which are the largest payor for nursing home care. Advocates and some researchers have argued that nursing homes, particularly for-profit ones, can afford to pay employees more and hire additional staff if they forsake some of the profits they give investors.

“Certainly, facilities haven't put all the dollars back into direct care over the years,” said David Grabowski, a professor of health care policy at Harvard Medical School. “But for certain facilities, it's going to be a big lift to pay for” higher staffing levels, he said in an interview last week.

In a written statement to KFF Health News, Jonathan Blum, CMS' principal deputy administrator and chief operating officer, said the study had been posted in error. “CMS is committed to holding nursing homes accountable for protecting the health and safety of all residents, and adequate staffing is critical to this effort,” he said. “CMS's proposal is being developed using a rigorous process that draws on a wide range of source information, including extensive input from residents and their families, workers, administrators, experts, and other stakeholders. Our focus is on advancing implementable solutions that promote safe, quality care for residents.” Blum's statement called the study a “draft,” although nothing in the 478-page study indicated it was preliminary.

The study has been widely anticipated, both because of the central role the administration said it would play in its policy and because the last major CMS study, conducted in 2001, had concluded that nursing home care improves as staffing increases up to the level of about one worker for every six residents. The formal metric for that staffing level was 4.1 staff hours per resident per day, which is calculated by dividing the number of total hours worked by nurses and aides on duty daily by the number of residents present each day.

CMS never adopted that staffing ratio and instead gave each nursing home discretion to determine a reasonable staffing level. Regulators rarely cite nursing homes for insufficient staffing, even though independent researchers have concluded low staffing is the root of many nursing home injuries. Too few nurse aides, for instance, often means immobile residents are not repositioned in bed, causing bedsores that can lead to infection. Low staffing also is often responsible for indignities residents face, such as being left in soiled bedsheets for hours.

Children account for one-third of Louisiana's Medicaid roll removals

The new research was conducted by Abt Associates, a regular contractor for CMS that also performed the 2001 study. But the report, in an implicit disagreement with its predecessor, concluded there was “no obvious plateau at which quality and safety are maximized or ‘cliff' below which quality and safety steeply decline.” Abt referred questions about the study to CMS.

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The study evaluated four minimum staffing levels, all of which were below the 4.1 daily staff hours that the prior study had identified as ideal. The highest was 3.88 daily staff hours. At that level, the study estimated 0.6% of residents would get delayed care and 0.002% would not get needed care. It also said that staffing level would result in 12,100 fewer hospitalizations of Medicare residents and 14,800 fewer emergency room visits. The report said three-quarters of nursing homes would need to add staff to meet that level and that it would cost $5.3 billion extra each year.

The lowest staffing level the report analyzed was 3.3 daily staffing hours. At that level, the report said, 3.3% of residents would get delayed care and 0.04% would not get needed care. That level would reduce hospitalizations of Medicare residents by 5,800 and lead to 4,500 fewer emergency room visits. More than half of nursing homes would have to increase staff levels to meet that ratio, the report said, and it would cost $1.5 billion more each year.

Charlene Harrington, a professor emeritus of nursing at the University of California-San Francisco, said CMS “sabotaged” the push for sufficiently high staffing through the instructions it gave its contractor. “Every threshold they looked at was below 4.1,” she said. “How can that possibly be a decent study? It's just unacceptable.”

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News' free Morning Briefing.

Louisiana Illuminator is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and Twitter.

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Domestic violence shelter funding cut in Gov. Jeff Landry’s budget plan

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lailluminator.com – Julie O'Donoghue – 2024-02-25 10:45:11

Domestic violence shelter funding cut in Gov. Jeff Landry's budget plan

by Julie O'Donoghue, Louisiana Illuminator
February 25, 2024

Gov. Jeff Landry's proposed state budget slashes funding for domestic violence victims by millions of dollars starting July 1, even as the governor says crime victims and public safety are his top priority.

State and federal funding for domestic violence shelters could go from $14.6 million in the current fiscal year to just $6.2 million in the next cycle, according to advocates for domestic violence victims. It would be the lowest level of funding for the shelters since Gov. Bobby Jindal was in office 10 years ago. 

If the cut goes through, the Louisiana Coalition Against Domestic Violence will have to pull back on plans to add more shelter beds across the state. It would put the brakes on opening up five new shelters and expanding six of 16 existing facilities, executive director Mariah Stidham Wineski said. 

“The new shelters that are opening will shut down,” Wineski said.

Domestic violence is one of the largest public safety issues facing Louisiana. In 2020, the state had the fifth highest female homicide rate in the country. More than half of women victims that year were killed by an intimate partner, according to the Violence Policy Center

It's unclear what led the Landry administration to propose a cut to funding for domestic violence shelters. The governor's office has not responded to a question about why the money was removed. A spokeswoman for the Department of Children and Family Services, where much of the funding is housed, declined to comment.

Most of the cut, $7 million, came from the removal of state money the Louisiana Senate added for shelters in 2023. Wineski and other advocates said lawmakers told them the funding increase would be ongoing and baked into the family welfare budget for years to come.

But when Landry took office in January, he stripped down the state spending plan in preparation for a significant financial downturn next year. He took out money for dozens of programs legislators added in 2023, including for domestic violence shelters, higher education and economic development.

Landry and lawmakers will face annual budget shortfalls of over half a billion dollars after a 0.45% state sales expires in 2025. The governor said he wants to start limiting state spending this year to make it easier to deal with smaller, leaner budgets in the future.

Yet Landry isn't sparing any expense when it comes to other public safety measures he is personally pushing. 

State lawmakers are swiftly moving a package of Landry's bills through a special session on crime. They are expected to add millions of dollars in prison expenses each year by lengthening the time incarcerated people stay behind bars.  

At the same time, domestic violence shelters face reductions in funding, the governor has asked lawmakers to approve approximately $10 million more for a new state police troop for New Orleans and $3 million to send Louisiana National Guard members to the Texas border with Mexico over the next four months. 

Landry said he is pushing these changes to benefit crime victims, but advocates for domestic violence shelters wonder why then their organizations haven't been made a budget priority alongside state police and prisons.

“Every single person we are serving is a victim of crime,” said Julie Pellegrin, executive director of The Haven, a domestic violence shelter that serves Terrebonne, Lafourche and Assumption parishes. 

A 2021 investigation by the Louisiana Legislative Auditor concluded the state desperately needed more shelter beds for domestic violence victims. Louisiana's 16 shelters had a total of 389 spaces, while Louisiana had an average of 2,700 unmet requests for shelter beds every year.

The audit noted no domestic violence shelter exists in central Louisiana, even though Rapides Parish had the 10th highest number of protective orders issued in the state in 2020. 

Wineski has been able to open a shelter in Iberia Parish after receiving a small boost in federal funding from the state a few years ago. The funding increase last year was expected to take shelter bed capacity around the state from around 390 to at least 600 slots, she said.

New facilities had been planned or recently opened in Livingston, Lafourche, St. Tammany, Caddo and Avoyelles parishes. The Avoyelles location would have helped fill the shelter gap in central Louisiana. 

“Domestic violence shelters do keep people alive,” Wineski said.

Iris Domestic Violence Center in Baton Rouge is one of the domestic violence shelters that received more state funding this year. (Julie O'Donoghue/)

At The Haven in Houma, Pellegrin used the extra state money to open up shelter beds and provide outreach services to remote portions of Assumption, Lafourche and Terrebonne. 

A parent can be reluctant to leave an abusive relationship if it means they have to cross parish lines and send their children to a different school, she said. By having more locations, her organization can reach more people.

This year's funding increase is the first hike in state support The Haven had seen in more tha 10 years, Pellegrin said. If Landry cuts that funding in the next cycle, she'll have to close some of the satellite locations she only recently opened.

The Haven's emergency shelter operates at near total capacity yearound already.

“When you make that phone call [to get help from a domestic shelter], you may have to wait,” she said. 

In the Baton Rouge region, Iris Domestic Violence Center was using the money this year to expand its shelter capacity and provide children's programming. 

Construction is already underway on playrooms, study areas and a teen library at Iris. Executive director Patti Joy Freeman also hopes to add a music room  to the facility with donated instruments for children.

Freeman said programs for children and teens are as important as what is offered to the adult victims. Teenagers in abusive families often take on a lot of responsibility helping raise younger children and need space of their own. 

All children also need counseling and programming to ensure the familial cycle of violence is broken, according to Freeman. Those types of resources are crime prevention tools because they help keep domestic violence at bay.

But Freeman won't have the resources to open the new children programs at Iris if state funding for domestic violence shelters gets cut next year. She won't be able to afford the extra staff and utilities needed to run the program. 

“I have to be a good steward with our money,” she said.

Before coming to Iris, Freeman oversaw domestic violence investigations for the East Baton Rouge Sheriff's Office. A former law enforcement officer, she considers shelters and their programs to be essential to fighting crime. Some victims feel comfortable coming to a shelter for help long before they are willing to interact with police, she said.

“Why are we wondering why these statistics don't go down when we only have 16 shelters with wraparound services?” she said.

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Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Louisiana Illuminator maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and Twitter.

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IVF patient vows to fight for access to treatment in Alabama following court ruling

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lailluminator.com – Kelcie Moseley-Morris – 2024-02-25 10:00:39

IVF patient vows to fight for access to treatment in Alabama following court ruling

by Kelcie Moseley-Morris, Louisiana Illuminator
February 25, 2024

Birmingham resident Hannah Miles has been trying to have a baby for more than three years, fighting obstacles like endometriosis, diminished ovarian reserve and cancer treatment that affected her husband's sperm.

The couple is already nearly $40,000 into the in vitro fertilization process after one failed transfer into her uterus in January. Their last embryo is scheduled to be transferred March 19.

She messaged her IVF nurse through tears earlier this week, asking if she should continue the medication injections that cost $800 per vial out of pocket to keep her endometriosis from flaring up.

Her clinic, Alabama Fertility, indicated her transfer can move forward, she said, but it has paused any new treatments or transfers because of the Feb. 16 ruling from the Alabama Supreme Court declaring that frozen embryos are equivalent to human children. The clinic made a post on its Facebook page Thursday addressed to patients.

That means Miles won't have another shot at egg retrieval for the foreseeable future in Alabama if this one doesn't work.

Trump comes out against Alabama IVF ruling as national Republicans scramble for distance

IVF requires the collection of as many eggs as possible that are then fertilized. Some that would not make it after implantation in the uterus because of abnormalities or other health factors are destroyed. That could leave clinics open to prosecution as a result of the new ruling.

“It's heartbreaking, and it's something you don't think you'll ever have to face,” Miles, 29, said. “Now we're here, and we're paying $20,000 a cycle in the hopes that maybe one day we'll get a baby, and now we're facing not even being able to pay exorbitant amounts of money to be able to have a baby.”

The 8-1 decision, authored by Justice Jay Mitchell, has already led more clinics in Alabama to pause IVF treatments, including the state's largest hospital, the University of Alabama Birmingham, for fear of prosecution. Companies have also decided to stop shipping frozen embryos to and from Alabama, according to RESOLVE: The National Infertility Association.

The ruling came as a shock to many Americans, but experts say it is the culmination of more than 40 years of efforts to grant “personhood” status to embryos and fetuses.

State Sen. Tim Melson, chairman of the Alabama Senate Healthcare Committee, plans to introduce a bill that would protect IVF by saying an embryo should be considered a potential life but not a human life unless and until it is implanted in the uterus and a viable pregnancy can be detected. As of Friday, Feb. 23, Melson's legislation hadn't been introduced yet.

Miles and a few friends are hoping to make it to the Alabama Capitol on Feb. 28 for an advocacy day and to testify at a public hearing on a similar bill introduced by Democrats, House Bill 225, if it's being heard.

“We have to do something about it,” Miles said. “It feels like there's not much we can do, but we have to do something.”

Previous ‘personhood' efforts failed

It's unclear whether the bill will conflict with the concurring opinion authored by Chief Justice Tom Parker, who wrote, “… any legislative (or executive) act that contravenes the sanctity of unborn life is potentially subject to a constitutional challenge under the Alabama Constitution.”

Parker has long been active in the anti-abortion rights space, and his opinion quoted extensively from the Bible, using religious reasoning for the decision — something he has often done during his time on the court, according to ProPublica reporting from 2014. He worked at former chief justice Roy Moore's think tank, the Foundation for Moral Law, which promotes the idea that the Bible should be the basis of the law in America and championed the “personhood” movement in Alabama. Parker also served as Moore's spokesperson during the controversy over a Ten Commandments monument that ultimately got Moore ousted from his position as a judge in 2003.

Margaret Marsh, historian and professor at Rutgers University, said many anti-abortion groups have opposed the fertility treatment since the world's first IVF baby was born in 1978, calling it a “morally abhorrent” technology and successfully lobbying against federal funding for research using human embryos.

“Their goal was to try to make sure that the American people would think of embryos as people,” Marsh said.

Alabama Attorney General's Office: No plans to prosecute IVF families, providers

In 1983, the U.S. Senate held a vote on the passage of a constitutional amendment to declare that human life begins at conception, but the measure was defeated. In the following years, at least 38 states passed “fetal homicide” laws that allowed prosecution for the death of a fetus as a result of domestic violence or other assault, and some included the option to prosecute a pregnant person for using drugs that caused the death of a fetus.

But attempts to go further at the state level largely haven't been successful, Marsh pointed out. In 2011, an initiative on the ballot in Mississippi that would have granted full personhood status to fertilized eggs failed by a vote of 57% to 42% after doctors and abortion rights groups raised concerns about the consequences it could have for birth control, IVF and other reproductive care. A similar measure in North Dakota failed in 2014 by an even wider margin, 64% to 35%.

“If these things are put to a vote, for the most part, the voters have turned them down, and I think it is likely because they are thinking of either themselves needing infertility treatment, or their friends, or their sisters,” Marsh said. “So they may be anti-abortion, but I don't think they see assisted reproductive technology in the same way they see being pregnant and having an abortion.”

Legislation weighed in other statehouses

Several state legislatures have considered bills this year that relate to “fetal personhood” laws, including Kansas, Florida and Idaho. A bill in Idaho to change the words “embryo” and “fetus” in state law to “preborn children” was pulled back earlier in the session when a doctor from a local IVF clinic raised concerns about its implications for fertility treatments.

Kansas' bill specifies that the embryo must be “in utero,” but it would allow pregnant people to seek child support at any stage of gestation. Representatives for Planned Parenthood in Kansas said it's a tactic to open the door for anti-abortion laws, two years after voters soundly rejected an attempt to amend the constitution to ban abortion in the state.

In Florida, the legislature is considering a bill that would add a fetus to those who could be counted in a wrongful death lawsuit. An amendment would establish that the fetus is a person from conception, according to Florida Phoenix.

The state with one of the most successful personhood laws is Georgia, where abortion is banned after six weeks, and any embryo or fetus with detectable cardiac activity can be claimed as a dependent on a resident's tax returns.

Shana Gadarian, a political scientist professor at Syracuse University who studies public opinion, said despite the support at the legislative level for such laws, she's not sure this latest development out of Alabama will be politically popular with the majority of the country.

“IVF is a pretty common procedure now, and if someone directly hasn't gone through it, it is relatively common among groups that are more likely to be conservative,” Gadarian said. “These are procedures people think of as important in their own lives and are probably separable from abortion.”

Polling from Pew Research Center in 2023 found that 42% of adults in the U.S. say they or someone they know has used fertility treatments, and a majority of Democrats and Republicans surveyed thought insurance should cover the treatments. Less than half of the country has mandated insurance coverage for IVF, according to Stateline.

Whatever happens next, Miles said she's ready to contact her representatives at the local, state and federal levels to change the laws, including helping to elect Democrat Greg Griffin, who's running to replace Parker as chief justice of the Alabama Supreme Court.

“Until IVF is protected at the federal level, we are all at risk of having something like this happen,” Miles said. “There is no one angrier at the world than someone going through IVF. They've pissed off the wrong people.”

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Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and Twitter.

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AP calls race for Trump as soon as polls close in South Carolina

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lailluminator.com – Abraham Kenmore – 2024-02-24 18:53:36

AP calls race for Trump as soon as polls close in South Carolina

by Abraham Kenmore, Louisiana Illuminator
February 24, 2024

COLUMBIA, S.C. – Former President Donald Trump won an expected blowout victory Saturday over former Gov. Nikki Haley in the South Carolina Republican presidential primary.

The Associated Press called the race at 7 p.m. with 0% of the precincts reporting.

“This is a little sooner than we anticipated and “an even bigger win than we anticipated,” Trump said as he took the stage to Lee Greenwood's “God Bless the USA.” He told supporters who had been gathering at the fairgrounds in Columbia all day, “You can celebrate for about 15 minutes and then we have to get back to work.”

The candidates and their allies have spent the past month pushing their message to voters across the state. Trump held Get Out the Vote rallies in Conway, North Charleston and Rock Hill, and a Fox town hall in Greenville, while his proxies toured the state. Haley meanwhile spent weeks crisscrossing the state on her tour bus.

Trump has held a steady lead over every other primary opponent in the Palmetto State since last spring, according to polling aggregator 538.

The former president also made international news during his visits to South Carolina, including saying he told the head of a NATO ally he would encourage Russia to “do whatever the hell they want” if they did not meet defense spending goals.

Messages like that rang true for Andrew Middleton, a 40-year-old IT network engineer in Charleston, who said he wants a president who will keep the U.S. out of foreign conflicts and focus on a domestic agenda. Middleton, who grew up in rural Illinois but has lived in the Charleston area for 12 years now, pushed his young son in a stroller as he walked out of West Ashley High School in the Lowcountry after casting his ballot for Trump.

Haley, the U.S. ambassador to the United Nations during Trump's administration, attacked the former president over his comments, and President Joe Biden said the remarks were “shameful” and “dangerous.”

Trump's comments, however, did not lessen enthusiasm for the former president at the polls.

“If anybody can get things straightened out quickly, it'll be him,” said Charleston-area voter Amy Coffey.

Saturday marked the first time the 48-year-old office administrator had cast a ballot in a primary. She said the current presidential race felt “crucial” to her and Malcolm Coffey, a 49-year-old electrician, prompting them to come out.

Both cast ballots for Trump, citing border security as the top issue concerning them.

“It's not that I don't like Nikki Haley,” Amy Coffey said. “ I just don't think now is the perfect time to bring someone new in. She'll have her time.”

Former South Carolina Gov. and U.N. Ambassador Nikki Haley casts her ballot in the South Carolina Republican primary on Feb. 24, 2024, in Kiawah Island, South Carolina. (Justin Sullivan/Getty Images)

Haley has been careful to manage expectations for her results in South Carolina, saying victory would be “making sure it looks close” rather than winning outright.

“All I can do is my part; I don't know if it will make a difference or not,” said Colleen Geis, a 48-year-old medical care coordinator living in the Charleston area who voted for the perceived long-shot Haley.

While Haley cast her own ballot on gated Kiawah Island, Geis was among a steady stream of James Island residents who stepped into the polling place at Harbor View Elementary.

Some living in the surrounding neighborhood used the opportunity to walk their dogs as they fulfilled their civic duty.

“Anybody but Trump,” said Lauren May, a 32-year-old doctor's assistant, after casting her vote.

Haley also earned the support of Mark Leon. The 51-year-old marketing consultant said 2016 was a difficult year. It was the first time he saw people become emotional and angry over politics. It was the first time he saw lifelong friendships end based on who they voted for.

“It's only going to get worse this year because it's the same players,” Leon said of a Trump-Biden faceoff.

He felt if Haley were chosen as the Republican nominee, she would bring more empathy to the race rather than instantly polarizing an issue.

On Tuesday, Haley gave a defiant speech in Greenville where she reiterated that she plans to stay in the race until Super Tuesday on March 5, when 15 states will vote.

“I feel no need to kiss the ring,” she said in that speech. “And I have no fear of Trump's retribution. I'm not looking for anything from him.”

According to the Election Commission, 205,099 people voted early in the primary and 12,018 people had cast absentee ballots ahead of Saturday.

That number far greater than the total number of South Carolinians who voted in the Democratic primary, which drew about 131,000 voters.

Haley is the last major candidate opposing Trump, but two extreme long-shot candidates remain in the running — Pastor Ryan Binkley of Texas and veteran Air Force combat pilot David Stuckenberg of Florida.

Three other candidates, Florida Gov. Ron DeSantis, biotech entrepreneur Vivek Ramaswamy and former New Jersey Gov. Chris Christie, all dropped out of the race after making it onto the South Carolina ballot.

This story will be updated.

This report was first published by SC Daily Gazette, part of the States Newsroom nonprofit news network with the . It's supported by grants and a coalition of donors as a 501c(3) public charity. SC Daily Gazette maintains editorial independence. Contact Editor Seanna Adcox for questions: info@scdailygazette.com. Follow SC Daily Gazette on Facebook and X.

Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Louisiana Illuminator maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and Twitter.

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