State Senator Nick Miller to Host Hearing on Nursing Home Sustainability and Costs

Pa State Senator Nick Miller (D-14), who chairs the Pa. Senate Democratic Policy Committee, will host a hearing on Thursday, 1 pm, concerning nursing home sustainability and costs. It will take place at Fellowship Community Center, located at 3020 Fellowship Drive, Whitehall, PA 18052. It will also be livestreamed here.

According to Miller, "This hearing will examine the sustainability of nursing homes, statewide and regional aging demographics, projected needs for the aging community, effects on the labor force, and actions we can take to keep these vital organizations open."

Big Beautiful Act is Big But Mostly Bad For Nursing Homes

Since the pandemic, Gracedale has been suffering from a perfect storm of resident deaths, staffing shortages, declining census and funding shortfalls that could have sunk the home but for the infusion of cash from the American Rescue Plan Act.  The county-owned nursing home is struggling valiantly to remain a last refuge for older (and even younger) people with nowhere else to go. Despite some negative comments on this blog, it has great support from the community. No one in or running for county office supports privatization, despite what you may hear on the campaign trail. There can be no dispute, however, that the current model is unsustainable because it relies too heavily on outside agency nursing care. A strategic plan to change that is far less Icarian than I would have expected. The American Rescue Plan and Cares Acts certainly helped Gracedale. But what about the recently enacted One Big Beautiful Bill Act (OBBBA)?  Is it good or bad for nursing homes?  I believe it's mostly bad and base this conclusion on reports from Skilled Nursing News and the AARP

1) It delays minimum staffing standards until 2034. - In 2024, the Biden administration finalized rules that would require nursing homes to provide 3.48 hours of nursing care to residents each day. While this delay has been blasted  because it obviously reduces skilled nursing care, it's incredibly stupid to impose such a requirement when nursing homes face unprecedented staffing shortages. This gives Gracedale and other LTCFs a bit of breathing room. 

2) It reduces retroactive Medicaid coverage. - Most residents at Gracedale have Medicare, but that only provides coverage for 100 days. To cover the cost, residents must also apply for Medicaid coverage. Under the OBBBA, Medicaid will cover medical expenses incurred for two months after they applied. Previously, there was a three-month window. Since residents at homes like Gracedale lack the financial means to pay these costs, the home would be forced to eat these costs itself, and that's expensive.

3) Home equity limit changes. - Under Pa. law, a person can apply for Medicaid, but the value of his primary residence is exempt it is worth $730,000 or less. The OBBBA increases that exemption to $1 million with no adjustments for inflation. While this might seem beneficial, it is likely to reduce the pool of people eligible for Medicaid as home values increase.

4) Dual Enrollment Changes for Medicaid and Medicare Delayed Until 2034. - Most Gracedale residents have both Medicare and Medicaid, but getting them enrolled in both programs successfully has been challenging. Under the Biden administration, two separate rules were adopted to simplify the process. The OBBBA delays implementation of these new rules until 2034, and this is estimated to reduce te number of "dual-eligible" residents by 1.3 million people.

Could "Community Villages" Help Our Elderly Population Better Than a Nursing Home?

Unlike most of the rest of the state, both Lehigh and NorCo both maintain nursing homes to care for the elderly. At least in NorCo's case, most would have a difficult time getting into a privately-run facility. Executive Lamont McClure has consistently maintained, both as a member of County Council and now as top dog, that it is our "moral obligation." Without doubt, it serves a meaningful humanitarian mission. But dark clouds loom on the horizon, and we should start studying alternatives that might actually do a better job of serving our elderly than packing them four to a room.

During COVID, we experienced the Great Resignation in which many employees left their jobs. This became a major problem at Gracedale, which at one point enlisted the national guard to provide nursing service. According to Skilled Nursing News, this problem remains. Turnover among CNAs alone is 44%, despite increases in compensation and other perks. Gracedale, like 60% of all nursing homes, is forced to rely on agency nurses and to decrease census, which in turn makes them unsustainable in the long run. The county could make a pitch for foreign workers, but given the current immigration climate, that seems to be a no-starter.

On top of the staffing crisis, there's reason to be concerned about the intergovernmental transfer, a creative financial mechanism under which counties pool their money to get a larger federal grant each year. Without that, Gracedale would have a far more difficult time breaking even. But it could be on the chopping block. Conservative think-tanks like Paragon Health Institute describe it as "money laundering." Even former President Joe Biden called it a "scam".

It's unclear to me whether the recently enacted Medicaid cuts will impact nursing homes. I refuse to engage in the histrionics of Hakeem Jeffries. But no one can dispute that the federal government is becoming less willing to fund our social safety net. 

With all of this in mind, let me introduce you to the "Villages of Baltimore County," which recently provided $50,000 to six nonprofits specifically to help our older population to age in place. There are 285 such villages nationwide. 

This is more than a plan for paying for home health care aides. Volunteers can help the elderly make it o doctor visits or grocery shopping. Scouting groups have planted community gardens with real and healthy food.

I believe something like this would be far less costly to the county and would give our older population a little more dignity than packing them into a room. 

What do you think?

Gracedale Not The Only Public Nursing Home With Staffing Issues

I've written numerous times about staffing issues at Gracedale, Northampton County's nursing home. It is relying heavily on outside agencies to provide nursing care. An operational assessment recently revealed that these nurses are paid 41% more than county employees. But Gracedale is far from alone. According to Lehigh Valley News, Lehigh County nursing home Cedarbrook is contracting out one-third of its nursing care to these outside agencies. 

Cedarbrook Administrator Jason Cumello told Lehigh County Comm'rs that these outside nurses just want cash and do not really care as much about benefits like a pension or healthcare. 

Cedarbrook and Gracedale are by no means outliers. Cumello also said that there is a 130,000-nursing home worker shortage nationwide.  AARP calls it a staffing apocalypse. 

In the midst of these vacancies, the Centers for Medicare and Medicaid Services have incongruously decided to increase the amount of direct nursing care required to 3.48 hours per resident per day. In March, Exec Lamont McClure told me that Gracedale was providing 3.7 hours of nursing care per day per person. 

Pa. Nursing Homes Get F From Watchdog Group

Families For Better Care, a national watchdog group that creates public awareness of nursing home conditions has released its latest report card. Pennsylvania not only gets a failing grade, but is ranked near the bottom of the barrel, at #46 overall.

Here are the key findings:

• Pennsylvania’s tanking nursing home care continued for the third consecutive report card, plunging the state’s ranking 14 spots to No. 46 overall and recording Pennsylvania’s first failing grade in any report.
• Dangerous conditions became more prevalent in Pennsylvania’s nursing homes as severe deficiencies swelled more than 80 percent since the last report card.
• Ninety-five percent of Pennsylvania’s nursing homes were cited one or more deficiencies.
• Pennsylvania’s nursing home residents continued to have a difficult time getting much needed help from caregivers as residents received fewer than 2 hours and 21 minutes of direct care per day.
• Pennsylvania is the MId-Atlantic Region’s lowest ranked state and the region’s only state to fail in care overall.

I've written extensively about problems at Gracedale, but Cedarbrook is now slipping, too.It had been rated as a five-star (much above average) by The Center for Medicare & Medicare Services (CMS), but that has now fallen to four stars.

A Department of Health inspection dated 1/31/19 resulted in eight citations directly related to resident care.

The most serious of these was a failure to provide and implement an infection prevention and control program (details in report).

Gracedale Rating Drops to Just One Star

The Centers for Medicare and Medicaid Services maintain a five-star rating system for nursing homes. Those with five stars are considered the best. Gracedale, Northampton County's nursing home, now has a rating of just one star, or "much below average." Human Services Director Allison Frantz advised Council of the latest drop on May 18, and even admitted that the County had known it was coming. She said the Department of Health was recently taken to task for inadequate oversight, and that Gracedale is paying the price. But of eight nursing homes within a ten-mile radius, Gracedale is the only one with a one-star rating.

At the end of last year, Gracedale had achieved a four-star rating. Then the slide began. In January, the rating dropped to three stars. In March, it dropped again to just two stars. Now it is just one.

Cedarbrook, the Lehigh County owned nursing home, has a five-star rating.

In addition to this drastic drop in its rating, Hayden Phillips is concerned that Gracedale is also losing residents. Last year, there was an average of 662 residents. Now, it is 650, which translates to over $1 million in revenue over a year. Frantz denied there is any correlation, and said that census increases over the year. She said it has been steady at 662 since April.

"One star is not who we are," said Frantz. She attributed the poor rating to what she calls "low level deficiencies."

Bob Werner also minimized the problem. "They nit pick, if I may use that term."

The state Department of Health lists 105 surveys for Gracedale online. These "low level deficiencies" include problems like openly displaying computer screens that display a patient's confidential information, unattended medication carts, forcing some residents to eat meals in restraints, failure to review resident drug regimens, failure to report possible abuse to state authorities and failure to notify family members of changes in a resident's medical condition. In March, Gracedale was cited after it was discovered that one resident was receiving three times the recommended daily dosage of a psychotropic drug.

Gracedale was also sanctioned with a $2,500 fine by the state Department of Health over numerous missteps in the way the facility responded to an attempted suicide.

Over the past year, Gracedale has been hit with 15 health deficiencies, which is twice the state and national average.        

These deficiencies reflect Gracedale' poor rating for "quality measures," which measures things like the use of psychotropic drugs, pain management, bed sores and infections. Gracedale has just one star in this category, which is considered "much below average." It had this rating through all of 2016 as well as this year.

Most nursing homes, including Gracedale, improperly use psychotropic drugs. At Gracedale, one of every four long-term residents receives antipsychotic medications, and 35% of the facility's long-term population are on anxiety or hypnotic drugs.

A 2011 study determined that 88% of Medicare claims for antipsychotics prescribed in nursing homes were for treating symptoms of dementia even though those drugs have never been approved for that use. Federal law prohibits the use of psychoactive drugs when they are just for the convenience of staff. There has to be a documented medical need for the drugs. Otherwise, they are considered "chemical restraints."

After an effort to sell Gracedale failed in 2011, Northampton County has made changes to help improve the facility. A privatized administrator runs the facility. There's an advisory board made up Gracedale supporters. Council Executive John Brown and Council have watched carefully for increases in overtime and other labor costs. Quality measures were never discussed in 2016, and only became a topic of discussion in March. That was after Peter Melan, a Democratic candidate for Council, criticized the County's failure to discuss quality measures.

Gracedale Administrator Raymond Soto is now telling Council that the nursing home is working on a plan to reduce the use of psychotropic drugs. But at the same time, he said many other nursing homes are getting increased scrutiny and are in the same boat as Gracedale. He and Human Services Director Allison Frantz both blamed a July 2016 performance audit by state Auditor General Eugene DePaaquale, calling on the state Department of Health to increase its oversight of nursing homes.

In a 25-mile radius of the county-owned nursing home, only one facility other than Gracedale has a one-star rating for "quality measures."

Beaver County Sheds Its 605-Bed Nursing Home

Earlier this week, I told you that five Pennsylvania counties will shed their public nursing homes this year. Beaver County sold its 605-bed home yesterday, reducing its staffing level by 600 people. Interestingly, Beaver's Board has a Democratic majority.

I have been informed that two other counties are "investigating options." Without a change in the reimbursement formula, this trend will likely continue.

LV Nursing Homes Facing $5.9 Million in State Budget Cuts

The Gracedale Gang is very busy these days. They did once call themselves the "Gracedale Guardians," but now refer to themselves as the "Watchmen."  Well, they need new glasses. They've been very busy in recent weeks, calling Executive John Stoffa a crook. They're still stomping all over former Council member Ron Angle, who lost his seat in November's election. They've also been trashing Easton Mayor and Gracedale supporter Sal Panto. Why? I have no degrees in psychology so it's hard to understand that one.

As much as they hate these elected officials, they hate me even more. I'm "vermin," "demented," "deranged," etc., with a "twisted pen."

While these supposed watchmen have been hurling hate grenades at all their imagined enemies, Governor Tom Corbett and the feds have been using meat cleavers to hack away at nursing home budgets.

According to some real watchmen at the Pennsylvania Health Care Association, the impact of Corbett's budget cuts on Northampton County nursing homes will be $2,121,441. Lehigh County, will suffer even more, losing $3,809,190. That's $5.9 million in cuts to LV nursing homes. By the way, Corbett's $102 million statewide cut for nursing homes is in addition to reductions in Medicare payments.

This financial strain is too much for the County. It's one of the reasons the County wanted to sell. Here are the sorry facts, according to a PHCA news release:

 Over the last four years, the state has paid nursing homes $1 billion less than the actual cost of care for Medicaid residents. Last year, the gap between the cost of care and what nursing homes are reimbursed for that care widened by 27 percent, from a loss of $15.13 per resident per day to $19.23 per resident per day. Nursing homes lose an average of $7,000 per Medicaid resident per year.

 Where other health-care providers, including hospitals and doctors, can make up lost Medicaid dollars through a variety of other funding sources, including private pay and health insurance, nursing homes can’t. Two-thirds of all nursing home residents are on Medicaid. That makes nursing homes far different than any other health-care provider.

 Nursing homes historically countered Medicaid shortfalls with Medicare revenue. That’s no longer the case, and it’s not even possible anymore. Here’s why:

o In October, a new federal rule took effect that cuts Medicare payments to nursing homes by 18 percent, or nearly $300 million. The cuts reset the base payments to nursing homes, meaning they continue year after year.

o The payroll tax cut extension enacted in February forces nursing homes to absorb $46.4 million in uncompensated care over the next three years. Pennsylvania’s cut is the fourth highest nationally, ranking only behind Florida, Illinois and Ohio.

o These cuts come on the heels of $14.6 billion being stripped nationally from nursing homes ($1 billion in Pennsylvania) under Medicare to pay for federal health-care reform.

o The cuts are compounded by an additional $500 million reduction Pennsylvania nursing homes face because of the federal super committee failed to reach a debt agreement.

These supposed watchmen, who actually want a seat on the Gracedale Advisory Panel, are happily casting stones at their perceived enemies. At the same time, these "guardians" - people like Mary Ann Schmoyer and Fake Rev Mario Martinez  - embrace a documented racist, GOP delegate candidate Tricia Mezzacappa. An  Easton police officer concluded Mezzacappa's vocabulary is "tinged with hints of racial bias." They consort with her while the Guv' is happily chopping away.

New Jersey Counties Selling Public Nursing Homes

According to The New Jersey Herald, only 11 of New Jersey's 21 counties still have nursing homes that receive state Medicaid reimbursement.

[I]n the recent past, Mercer, Salem and Cumberland counties have sold their nursing homes while Burlington County is in the process. Middlesex County "sold" its nursing home to a newly-created improvement authority, but has bought the facility back.

Sussex County is in the process of selling its facility, called The Homestead, which was first opened in 1955. Opponents of the sale are circulating petitions and have set up a Facebook page.

Updated 11:45 AM: In New York, only 16 of 57 counties outside of the Big Apple still own their nursing homes, and half of those are considering a sale. In Washington County, where the sale of what was once its poor home is being considered, the Controller points to declining Medicaid reimbursements.

92% of Nursing Homes Employ Convicted Criminals

"More than 90 percent of nursing homes employ one or more people who have been convicted of at least one crime, federal investigators said Wednesday in a new report. In addition, they said, 5 percent of all nursing home employees have at least one criminal conviction."

That's according to The New York Times, citing a recent report of the Inspector General. This is in spite of a criminal background check required by most states. Most of these crimes are for theft or drug use, not patient abuse.

Gracedale Initiative: The Case Against Government by Mob Rule

I've been one busy beaver the past week or so, spending so much time in the Northampton County elections office that the ladies there have threatened to file PFAs against me. I've been reviewing 507 petitions filed to prevent the County from selling nursing home Gracedale, one of its own assets, and one that loses money. After noticing several disturbing patterns in the petitions, as well as a facial inconsistency between the Home Rule Charter and the Elections Code, I decided that a lawsuit had to be filed. What's more, it had to be filed yesterday.

I won't bore you with all the legal gobbledygook, but after discussing this matter with Northampton County Bulldog Ron Angle, we formed an Unholy Alliance to stop government by mob rule.

Yesterday, shortly before the Elections Commission convened, we filed a suit challenging the validity of 23,391 unverified signatures filed by a group led by a fake preacher, who's probably cooking up a batch of Kool Aid for his group right now. I've attached the full Complaint below, but want to summarize the points made to the Elections Commission yesterday, which ultimately ruled against the Initiative, 3 to 2.

1) Ellen Weiss was a petition circulator, i.e a person who watches you sign the petition and later swears that she saw you sign it. She just happens to be the President of AFSCME. She's a VP of the LV Labor Council. Her husband is their Recording Secretary. She's one of the union cadets who used the Gracedale rally as an excuse to campaign for Charles Dertinger and John Callahan. She circulated 37 of the 507 petitions, getting 2,269 signatures. On Election Day alone, she obtained 1,229 signatures between 7 AM and 8 PM in at least 8 different municipalities, and in places as far apart as Hellertown and Pen Argyl. Assuming she spent just one hour driving to different polling places, eating and using the facilities, she would have to have obtained one signature every 35 seconds. That's a physical impossibility. We are asking the Court to strike all 2,269 signatures to preserve the integrity of the election process.

2) Dana Lorin Paisley is another petition circulator whose claims are simply unbelievable. He supposedly obtained 1,188 signatures, and 537 of them were on Election Day alone, from Walnutport to Wilson Borough. That's 41 per hour between 7 AM and 8 PM.

3) Mary Ann Schmoyer is a woman who disrupts nearly every meeting with catcalls ad curses at Angle. She even called him foul names in front of a group of around 40 boy scouts. Well, she was a petition circulator, too, collecting 47 of the 507 total, getting 1,439 signatures. At any given point in time, she had as many as 15 different petitions. She was obviously dropping them off at bars and clubs. Now she claims to have set up tables and laid 15 out at a time, but even then, she is not witnessing each signature.

4) Circulator Jack DAllesander, one of the blog trolls here who incessantly attacks Angle and anyone who supports Gracedale's sale, is physically disabled. He has breathing tubes coming out of his nose, ears and practically every orifice. He can't walk or speak without them, and has claimed that on this very blog. But there he is on Election Day, supposedly obtaining 301 signatures. He is saying his equally disabled wife helped him.

5) Circulator Clayton Creamer is a non-county resident who handed in two petitions, and one of them is all filled out with the same handwriting. That's 53 signatures.

6) Betty Fensetermaker obtained 99 signatures and is not herself a registered voter.

7) Wendy Haggerty obtained 583 signatures. Holly Guzaman got another 97. Their addresses do not match information at the elections office. (This is a curable defect).

8) Petitions were fraudulently circulated in Bethlehem Township and Easton. I have several witnesses, but Bethlehem Township Planning Chair Lee Snover saw it go on all day. Circulators were making the following false statements to voters: "Gracedale not only is closing; they are moving the patients two or three Counties away; their family is never going to see them again.” Approximately 700 signatures come from those 2 districts.

9) Jerry Green and Tim Rehrig are the President and Business Manager of the Steelworkers bargaining unit at Gracedale. They both make over $60,000 per year. Neither are residents of Northampton County, but they both circulated petitions in a matter in which they have a financial interest, getting 300 names.

10) Ladd Siftar notarized his own signature. That's 1.

11) In just half of the 507 petitions on file, there are 1,238 defective signatures (not registered, wrong County, etc.).

If you add it all up, that's 8,267 bad signatures. That means the 15,124 valid signatures are way below the 19,630 threshold need for ballot initiative. So if you forget the Home Rule Charter's express prohibition on initiatives or referenda that interfere with the budget or a capitol program, this effort still falls short.

Gracedale Complaint