Nursing Home Care in the Spotlight

Published in the Woonsocket Call on August 4, 2019

Following on the heels of its March 6 hearing, “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes,” the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,” on July 23, in 215 Dirksen, to study proposed reforms to reduce neglect and abuse in the nation’s nursing homes and to put a spotlight on the need to reauthorize key provisions of the Elder Justice Act.

During the two hour and twenty-minute morning hearing, Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Oregon) along 11 members of the Senate committee listened to the testimony of five panel witnesses.

In his opening statement, Grassley acknowledged that the work isn’t done yet to improving the care in the nation’s nursing homes and Congress must protect nursing home and assisted living residents and those in group living arrangements from harm. The Iowa Senator noted in the recently released U.S. Government Accountability Office (GAO) report the federal agency that provides auditing, evaluation, and investigative services for Congress, noted that while one-third of nursing home residents may experience harm while under the care of these facilities, in more than half of these cases, the harm was preventable.

Calls for Bipartisan Efforts to Improve Nursing Home Care

Grassley called on Congress to reauthorize programs, such as the Elder Justice Act, to put the brakes on the growing trend of elder an abuse fueled by social media.

Adds, Wyden, in his opening statement, there is now an opportunity for Congress to come together to hammer out bipartisan legislative reforms to fix the nation’s nursing home oversight efforts. He urged his fellow Senate committee members to work to reduce the instances of physical, sexual, mental and emotion abuse in nursing homes, that appears to be increasing. He also called for a redo to the federal nursing home rating system because it does not reflect the increased prevalence of abuse.

During the first panel, Megan H. Tucker, Senior Advisor for Legal Review, of the HHS Office of Inspector General (OIG), stated that abuse and neglect oftentimes are not properly identified, reported or even addressed. While most providers are delivering good care, Tucker warned that Health and Human Service safeguards are lacking.

Tucker testified that the Centers for Medicare and Medicaid Services (CMS) should use data more effectively and close the gaps in their reporting process to ensure that abuse and neglect are identified and the deficiencies corrected.

Concluding the first panel, John E. Dicken, Director, Health Care, of the U.S. Government Accounting Office (GAO), discussed a newly released GAO report, released at the hearing, that detailed a growing trend of abuse and neglect of residents. According to one GAO report findings, abuse deficiencies more than doubled between 2013 (430) and 2017 (875), with the greatest increase in actual harm and immediate jeopardy deficiencies, and that abuse is still under-reported, he said. The GAO report also expressed concern over “significant gaps” with CMS’s oversight.

Leading the second panel, Robert Blancato, Coordinator of the Elder Justice Coalition, called on Congress to reauthorize, the Elder Justice Act. With elder abuse becoming a “national emergency,” he urged lawmakers to dedicate funding for Adult Protective Services at the local and state levels. Blancato also stressed the importance of strengthening the long-term care ombudsman program, continuing the Elder Justice Coordinating Council, authorizing an Advisory Board on Elder Abuse, Neglect, and Exploitation, and finally funding for elder abuse forensic centers.

President and CEO, Mark Parkinson, of the Washington, DC-based American Health Care Association (AHCA), representing nearly 10,000 of the 15,000 plus nursing homes in the country who provide care to nearly four million individuals each year, stated he was not at the hearing to defend poor care but to provide solutions to Congress to prevent such incidents from happening again.

Fixing the Problem

Parkinson testified that over the past seven years, facilities participating in AHCA’s quality initiative, have shown improvement in 18 of 24 quality measures. Specifically, there are less hospital readmissions, fewer antipsychotic medications being prescribed, staff are spending more time than ever before with residents and today’s nursing homes are more person-centered care today than ever before.

Parkinson called on lawmakers to improve employee background check systems, add patient satisfaction data to CMS’s nursing home rating system, address the severe staffing shortage and to adequate fund Medicaid.

Finally, Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care, ended the second panel discussions, by warning that more must be done to protect nursing home residents from abuse.

Smetanka urged Congress to take steps to enforce minimum requirements for sufficient staffing, establish standards and oversight for nursing home ownership and operations, prevent rollback of nursing home regulatory standards, increase the transparency of information and to strengthen and adequately fund elder justice provisions.

Now, with the Congress putting poor nursing home care on its policy radar screen, both Democratic and Republic congressional leadership must work closely together to come up with bipartisan solutions. Fix this problem once and for all.

Senate Finance Committee members — Senators Lankford, Stabenow, Daines, Menendez, Carper, Cardin, Warner, Casey, Brown, Cortez Masto, and Hassan – attended the July 23 hearing

To listen to this Senate Finance Committee hearing, go to http://www.c-span.org/video/?462733-1/finance.

For a copy of the GAO report, http://www.gao.gov/assets/710/700418.pdf.

Democrats Put High Drug Costs on Radar Screen

Published in Woonsocket Call on September 30, 2018

On August 21, at an afternoon Democratic Senate hearing titled “America Speaks Out: The Urgent Need to Tackle Health Care Costs and Prescription Drug Prices,” Senators Debbie Stabenow (D-MI), Ron Wyden (D-WA), Chris Van Hollen (D-MD), Tina Smith (D-MN), Richard Durbin (D-IL), and Joe Manchin (D-WV), gathered to hear the personal stories of witnesses who have struggled with paying for the high cost of prescription drugs and listen to an expert who tracks price trends for prescription drugs widely used by older Americans.

In the last 18 years prescription drug prices have risen 3 times faster than physician and clinical services,” says DPCC’s chairwoman Stabenow in her opening statement. “We pay the highest prices in the world. The outrages prices force people to skip doses, split pills in half and even go without the medication they need,” she says, calling this problem a “matter of life and death,” says Stabenow.

Democrats believe health care to be a basic human right, while the GOP considers it to be a commodity to go to the highest bidder, adds Stabenow, denoting the philosophical differences of the two political parties.

Wyden, Ranking Member on the Senate Finance Committee who sits on the DPCC, recalled that two years ago when then presidential candidate Donald Trump was on the campaign trail pledged to make sure Medicare would negotiate like crazy to hold down costs for seniors and taxpayers. While Trump is well into one year and a half into his term, Americans year ad half into his term Americans believe it is crazy that we are still not negotiating to hold down the cost of medicine.

Wyden and his fellow DPCC committee members also call for Medicare to allow Medicare to negotiate prescription drug prices with pharmaceutical companies.

Senate DPCCs Puts Spotlight on Rising Drug Costs

At the Senate’s DPCC’s hearing, Witness Nicole Smith-Holt, a Minnesota state employee, and mother of four children shared a tragic story about her 26-year old diabetic son, Alec, who had died because he could not afford his copay of $1,300 for diabetic supplies and insulin.

The Richfield, Minnesota resident recounted how her son tried to ration the insulin to make it last until his next paycheck, but he died as a result of diabetic ketoacidosis.

Stahis Panagides, an 80-year old Bethesda, Maryland retiree, testified that he could not afford to pay $ 400 per month for prescribed Parkinson’s medication. He could not pay for the new course of treatment, recommended by his neurologist, even with a supplemental Medicare plan, he says, so he just refused to take it.

Retired social worker John Glaser, a long-time grassroots organizer for the Washington, DC-based National Committee to Preserve Social Security and Medicare, came before the Democratic committee, saying “Medicare drug benefits and the Affordable Care Act’s closing of the coverage ‘donut hole’ have made a huge difference in my life and are invaluable for the quality of my life. Without these improvements he would have spent about $5,000 one-of-pocket on prescription drugs last year, he notes.

Glaser also shared that his brother, who is afflicted with diabetes, heart problems, and kidney disease, takes over 50 pills every day. “If my brother had to pay the full price for all of those drugs, he’d be living on the street,” he says.

Marques Jones, who has Multiple Sclerosis (MS), told the Senators that his MS medication costs about $75,000 annually. Despite having robust insurance coverage, Jones’ annual out-of-pocket spending on drug co-pays and insurance premiums for his family of five is very high. This has caused the resident of Richmond, Virginia to become a vocal advocate for those who suffer from MS.

Finally, Leigh Purvis, Director, Health Services Research, AARP Public Policy Institute, a coauthor of the AARP Public Policy Institute’s annual RX Price Watch Reports, warned that today’s prescription drug price trends are not sustainable. “The current system is simply shifting costs onto patients and taxpayers while drug companies remain free to set incredibly high prices and increase them any time that they want,” says Purvis, noting that Congressional efforts to reduce prescription drug prices could save billions of dollars.

AARP Report Tracks Skyrocketing Drug Costs

One month after Senate’s DPCC’s hearing, a new AARP report, released on September 27, 2018, says that retail prices for many of the most commonly-used brand name drugs prescribed to older adults by older adults increased by an average of 8.4 percent in 2017, greater than the general inflation rate of 2.1 percent. The annual average cost of therapy for just one brand name drug increased to almost $6,800 in 2017, says the AARP researchers.

According to the new “Rx Price Watch Report: Trends in Retail Prices of Prescription Drugs Widely Used by Older Americans: 2017 Year-End Update,” released just days ago, revealed that for over a decade, brand name drug prices have “exceeded the general inflation rate of other consumer goods by a factor of two-fold to more than 100-fold.”

If retail drug price charges had reflected the general inflation rate between 2006 and 2017, the average annual cost for one brand name drug in 2017 would have been $2,178 instead of $6,798, said the AARP Public Policy report.

Taking multiple medications can be costly, says the AARP report. “For the average senior taking 4.5 medications each month, this would translate into an annual cost of therapy that is almost $21,000 less than the actual average cost of therapy in 2017 ($9,801 vs. $30,591), notes the findings of the AARP report.

“Despite years of relentless public criticism, brand name drug companies continue increasing the prices of their products at rates that far exceed general inflation,” said AARP Chief Public Policy Officer Debra Whitman, in a September 26 statement with the release of the AARP report. “It’s clear that we need long-term, meaningful policies that go beyond just hoping that the drug industry will voluntarily change its excessive pricing behavior,” adds Whitman.

“The average older American taking 4.5 prescription medications each month would have faced more than $30,000 in brand name costs last year,” adds Leigh Purvis, Director of Health Services Research, AARP Public Policy Institute, and co-author of the AARP report. “That amount surpasses the median annual income of $26,200 for someone on Medicare by more than 20 percent. No American should have to choose between paying for their drugs and paying for food or rent,” says Purvis.

Some highlights of AARP’s New Drug Cost Report

AARP report’s findings noted that brand name drug prices increased four times faster than the 2017 general inflation rate and that drug retail prices that year increased for 87 percent of the 267 brand name drugs studied.

Finally, research findings indicated that “retail prices for 113 chronic-use brand name drugs on the market since at least 2006 increased cumulatively over 12 years by an average of 214 percent compared with the cumulative general inflation rate of 25 percent between 2006 to 2017.”

In recent correspondence to the Secretary of the Health and Human Services, AARP calls for regulatory and legislative reforms that will allow the Secretary to be able to negotiate drug prices for Medicare, allowing the safe importation of lower cost drugs into the United States and ensuring that generic drugs can more easily enter the market. Now, AARP waits for a response.

Putting the breaks on the skyrocketing pharmaceutical costs might just be the bipartisan issue that the new Congress can tackle once the dust settles from the upcoming mid-term elections.

To watch DPCC’s August 21st Senate hearing, go to https://www.democrats.senate.gov/dpcc/hearings/senate-democrats-to-hold-hearing-with-americans-hurt-by-high-cost-of-prescription-drugs.

For a copy of AARP’s drug cost report, to http://www.aarp.org/rxpricewatch.