nursing home – R&R – Reachout and Rebuild

Why is COVID-19 Testing Important?

David Posnett — Sun, 29 Mar 2020 04:24:17 +0000

Earlier today, March 28, 2020 and According to News 12

Suffolk County Executive Steve Bellone says 4,138 people in the county have tested positive for coronavirus.

Bellone also says 409 people are hospitalized due to coronavirus, with 139 in the ICU. “There are 2,644 hospital beds, with 570 available. There are also 309 ICU beds, with 78 available.” Clearly, we will soon run out of necessary beds and of course ventilators.

Bellone says there are 30 deaths in the county due to coronavirus.

7 deaths have occurred in the retirement home Peconic Landing

At Peconic Landing, the Greenport retirement home, there was another death today, the seventh. There are about 40 people known to have tested positive. Peconic Landing has perhaps 377 staff, and well over 300 residents (301 independent “members” and 86 nursing home patients). Peconic Landing is the hotbed of COVID-19 in Suffolk county. Think of it as a “Cruiseship”. And it is full of frail elderly clients. Find the updated information regarding Peconic Landing and COVID here.

The leadership of Peconic Landing claims there are no available tests for their home. I understand that there may be a rush on tests, but isn’t the situation at Peconic Landing a quasi emergency? Their residents are mostly over 80 years old. If they get sick with COVID-19 one would expect a mortality rate of 10-20% at least. For the rest of us, the mortality (risk of dying if we get the virus) is more like 1-2% .

Some say “well aren’t they going to die anyway?” How would you feel if your parent or grandparent were there?

Why is it important to test everyone at Peconic Landing?

There are currently 2 types of testing:

RT-PCR test – it detects viral RNA and therefore a component of the virus itself. This involves a nasal swab that is sent to a lab and the turnaround is about 1-2 days currently.
Antibody test: A new test for IgM and IgG antibodies (Ab), which are part of the immune system’s response to the virus. This test takes 15 minutes and involves a pinprick of a finger, like the glucose test performed by diabetics.

Both tests should be done because the combined information might be useful:

Here are the 4 possible outcomes and what they mean.

PCR+ Ab –

you have COVID-19, symptomatic or asymptomatic. You should take precautions (self-isolation) to avoid transmission of virus to your loved ones. You absolutely may not have any contact with residents at a home, like Peconic Landing.

PCR+ Ab+

you are likely recovering from COVID-10 (1-3 weeks out); you may have been symptomatic or not. Because you are still PCR+ you need to take precautions (isolation). Isolation should be for 10 days after symptom onset or for the duration of symptoms plus 3 days after resolution of symptoms. You absolutely may not have any contact with residents at a home, like Peconic Landing.

PCR- Ab-

you never had COVID-19. You are susceptible, and if you live or work in a high risk situation, such as Peconic Landing, you shouldn’t be there. But if that is impossible, you should take very stringent precautions.

PCR- Ab+

you are fully recovered from COVID-19. Generally, this group could be considered “immune” and possibly

- go back to work
- might be well suited for caretaker and health provider roles
- might donate plasma at a blood bank to be administered to critically ill COVID-19 patients in the ICU: this is called passive immunotherapy, used successfully for the Spanish Flu and for Ebola.

On the Diamond Princess Cruise ship, all elderly passengers and those with underlying medical conditions, and all crew were tested. Passengers who had negative [SARS-CoV-2] RT-PCR test results, no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarking. In other words, testing helped make informed decisions to save as many lives as possible.

We should do the same for our senior friends at Peconic Landing.

You’re Probably Going to Need Medicaid

David Posnett — Tue, 13 Jun 2017 14:49:53 +0000

I could not say it any better… Mr.Zeldin’s vote will directly affect you and your family and you wont like it!

By DAVID GRABOWSKI, JONATHAN GRUBER and VINCENT MORJUNE 13, 2017

in the NYTimes Opinion Section

Photo Niko J. Kallianiotis for The New York Times

Imagine your mother needs to move into a nursing home. It’s going to cost her almost $100,000 a year. Very few people have private insurance to cover this. Your mother will most likely run out her savings until she qualifies for Medicaid.This is not a rare event. Roughly one in three people now turning 65 will require nursing home care at some point during his or her life. Over three-quarters of long-stay nursing home residents will eventually be covered by Medicaid. Many American voters think Medicaid is only for low-income adults and their children — for people who aren’t “like them.” But Medicaid is not “somebody else’s” insurance. It is insurance for all of our mothers and fathers and, eventually, for ourselves.The American Health Care Act that passed the House and is now being debated by the Senate would reduce spending on Medicaid by over $800 billion, the largest single reduction in a social insurance program in our nation’s history. The budget released by President Trump last month would up the ante by slashing another $600 billion over 10 years from the program. Whether the Senate adopts cuts of quite this magnitude or not, any legislation that passes the Republican Congress is likely to include the largest cuts to the Medicaid program since its inception.Much focus has rightly been placed on the enormous damage this would do to lower-income families and youth. But what has been largely missing from public discussion is the radical implications that such cuts would have for older and disabled Americans.

Medicaid is our nation’s largest safety net for low-income people, accounting for one-sixth of all health care spending in the United States. But few people seem to know that nearly two-thirds of that spending is focused on older and disabled adults — primarily through spending on long-term care services such as nursing homes.

Indeed, Medicaid pays nearly half of nursing home costs for those who need assistance because of medical conditions like Alzheimer’s or stroke. In some states, overall spending on older and disabled adults amounts to as much as three-quarters of Medicaid spending. As a result, there is no way that the program can shrink by 25 percent (as under the A.H.C.A.) or almost 50 percent (as under the Trump budget), without hurting these people.

A large body of research, some of it by us, has shown that cuts to nursing home reimbursement can have devastating effects on vulnerable patients. Many nursing homes would stop admitting Medicaid recipients and those who don’t have enough assets to ensure that they won’t eventually end up on Medicaid. Older and disabled Medicaid beneficiaries can’t pay out of pocket for services and they do not typically have family members able to care for them. The nursing home is a last resort. Where will they go instead?

Those who are admitted to a nursing home may not fare much better. Lowering Medicaid reimbursement rates lead to reductions in staffing, particularly of nurses. Research by one of us shows that a cut in the reimbursement rate of around 10 percent leads to a functional decline of nursing home residents (that is, a decline in their ability to walk or use the bathroom by themselves) of almost 10 percent. It also raises the odds that they will be in persistent pain by 5 % and the odds of getting a bedsore by 2 %.

Finally, these cuts would just shift costs to the rest of the government. Lower-quality nursing home care leads to more hospitalizations, and for Americans over 65, these are paid for by another government program, Medicare. One-quarter of nursing home residents are hospitalized each year, and the daily cost of caring for them more than quadruples when they move to the hospital. Research shows that a reduction in nursing home reimbursements of around 10 percent leads to a 5 percent rise in the odds that residents will be hospitalized. So care for seniors suffers, and the taxpayer pays.

Mr. Trump and the Republicans would lower spending on the frailest and most vulnerable people in our health care system. They would like most Americans to believe that these cuts will not affect them, only their “undeserving” neighbors. But that hides the truth that draconian cuts to Medicaid affect all of our families. They are a direct attack on our elderly, our disabled and our dignity.