Starbuck’s Fiscal ‘Tall’ Falls Short; Nursing Home Tool & More
Dec. 29, 2012 — Volume 12, Number 17
IN THIS ISSUE: Taking on 2013 – Easy as Falling Off a Cliff
1. PROPUBLICA UPDATES “NURISING HOME INSPECT” TOOL
2. GEN BEATLES NEWS:
Eric Laursen’s “The People’s Pension”a Choice Books2012 selection by American Library Association Magazine; ***RedwoodAge.com’s Cleverest Holiday Card
“Tall” Political Order by Starbucks CEO Is Decidedly a Small; ***Unchain That CPI; ***Progressives and the Safety Net
4. CALENDAR:
Off the Cliff with a Parachute –Two NASI Meetings at National Press Club: ***”Strengthening Social Security: What Americans Want,” Jan. 15; ***Medicare and Social Security in a Time of Budget Austerity,” Jan. 31-Feb. 1
Pregnancies, Aging and Disability”; *** States Shifting Medicaid Long-Term Support/Services to Manage Care
1. PROPUBLICA UPDATES “NURISING HOME INSPECT” TOOL
The Investigative News Site ProPublica has upgraded its free tool for reporters and researchers to compare nursing home deficiencies and penalties within a state-or across states, with relative ease. Senior Reporter Charles Ornstein
e-mailed noting the upgrade of Nursing Home Inspect, first unveiled in August “to search through tens of thousands of nursing home inspection reports to find problems and trends.”
The update, he explained, allows users to run a state-by-state comparison of nursing homes in such areas as “the number of deficiencies cited by regulators in the past three inspection cycles (roughly three years); the number of serious deficiencies per home (that is, deficiencies in which patients were put at immediate jeopardy of harm); the amount of fines imposed; and how often the government has suspended payments to the home for new patients, another type of penalty.”
A new mapping visual shows how states differ in average fines, serious deficiencies per home and payment suspensions.
Ornstein said that in their latest investigation, Two Deaths, Wildly Different Penalties, he and his colleague Lena Groeger “found big inconsistencies in the way in which the government punishes nursing homes for serious neglect and misconduct, sometimes resulting in deaths.”
For instance, an East Texas facility was fined only $9,500 by the federal Centers for Medicare and Medicaid Services (CMS) after a resident choked to death on a cookie in front of a staff untrained to handle emergencies or even call 911. Yet, a South Carolina company, Unihealth Post-Acute Care-North Augusta, was fined $305,370, following the death of a resident who pulled out her breathing tube and die, because the staff failed to take appropriate steps to keep her from harming herself.
According to Ornstein, in each state, inspectors working on behalf of CMS “cited the homes for their failure to operate ‘in an acceptable way that maintains the well-being of each resident.’ Both homes posed an ‘immediate jeopardy’ to residents’ health and safety, inspectors determined.”
A related tool, he said, allows reporters “to play around with our state level data to find stories yourself.”
Ornstein added, “I would love to hear any thoughts you have. We plan to update this as CMS releases more data.” Reporters can reach Charlie at charles.ornstein@propublica.org, Office: (917) 512-0222, Cell: (818) 679-9363.
2. GEN BEATLES NEWS
*** Eric Laursen’s, The People’s Pension, got tapped by the editors of Booklist as one of their Choice Books for 2012. The American Library Association magazine notes they seek volumes “that combine literary, intellectual, and aesthetic excellence with popular appeal.” Laursen e-mailed, “It’s flattering to be included on the same list as the latest installment of Robert Caro’s Lyndon Johnson bio and the great new book on the Amistad rebellion by the esteemed Marcus Rediker.”
*** Kudos to RedWoodAge.com’s Tom Murphy and Pam MacLean for the season’s cleverest card – “Merry Cliffmas!”
3. FISCAL REFORM SCHOOL
*** “Tall” is the Ego Order of Starbucks CEO Howard Schulz, which of course means “small,” in real java-size terms at the chain. Schulz, who co-founded the Fix the Debt group with other CEOs to pressure politicians into a bipartisan deal on the so-called fiscal cliff,” only ended up with a hot spill in his lap. He contacted the chain’s 120 DC-area franchises asking staff to jot “Come Together” on every cup. Also, he placed a rather vague full-page ad in the New York Times and other media Friday (Dec. 28) showing a red Starbucks up with “Come Together” scrawled on the side and a quote from Abraham Lincoln about struggling today for the “vast future.”
Sure, Mr. Schulz, I’ll order a Vast with low-fat foam and, hey, man, free the beans (along with your corporate tax rate).
Even at Forbes, blogger John McQuaid ( Starbucks ‘Come Together’ Fiscal Cliff Misfire ) chided, “‘Come Together'” may be the blandest possible political statement, but it is still a political statement . . . . What if you work at Starbucks and don’t agree with Fix the Debt’s bullet positions, which include a call for a Simpson-Bowles-like long-term debt solution, including lower tax rates across the board and unspecified entitlement cuts? Or, more starkly, what if you don’t think both sides should ‘Come Together’ at all, but that one side is right and the other wrong?”
Public reaction remains to be gauged, but one friend has already threatened to give up her beloved Starbucks egg-wich and -heaven forefend–return to McDonald’s for the Egg McMuffins.
*** Meanwhile, Unchain that CPI: Reporters need to take a very close look at “bipartisan” proposals for a supposedly even-handed bargain that includes allegedly minor adjustments to save billions on the federal budget. One that’s widely touted is changing how the government calculates the annual Social Security cost of living adjustment (COLA).
Veteran actuary Steve Vernon ( Chaining Inflation Gauge Would Hurt Social Security Recipients )
explained this week in MoneyWatch (Dec. 24) that apolicy lawmakers are considering as part of the “fiscal cliff” talks is a plan the president has proposed adopting what is known as the “chained” Consumer Price Index, or chained-CPI. It would, they say, reduce the nation’s deficit and raise revenue.
Vernon writes, “Advocates contend that this approach is a relatively painless way to shrink the government’s budget gap and to shore up the federal retirement program, which they contend is financially troubled.”
The idea behind the chained CPI is that the CPI that government currently applies overstates actual inflation, while the “chained-CPI assumes that as prices increase, consumers make substitutions in what they purchase. The common illustration is that if the price of beef increases but the price of chicken is stable, consumers will purchase less beef and more chicken.” Vernon notes that the Congressional Budget Office (CBO) estimated the chained-CPI “would save more than $220 billion over 10 years. The net savings would be considerably lower if Congress adopts measures to soften the blow to the most vulnerable Social Security recipients.”
Vernon adds, “In general, people who would be negatively affected by the use of the chained-CPI would be retirees and other beneficiaries who receive most of their income from Social Security and who aren’t in a position to switch to other goods and services when prices rise. For example, Medicare premiums and out-of-pocket medical expenses take up a large share of many retirees’ budgets. Many retirees have no alternative to Medicare, so for these people the only ‘substitution’ for medical care paid under the program is to go without it.”
He continues, “You might think, what’s the big deal if 37 percent of a retiree’s total income grows at a slightly lower rate? But averages can be deceiving. According to government statistics, median income for people over age 65 is roughly $20,000 a year. Social Security provides at least half of total household income for 65 percent of all aged beneficiaries. And for non-married beneficiaries, that figure rises to 74 percent, or nearly three-quarters of their income.”
Vernon goes on, “For more than a third of all older beneficiaries, Social Security provides 90 percent or more of total income, while for non-married beneficiaries that figure rises to 46 percent. These are the people who would suffer most under a chained-CPI, a group that encompasses more than one-third of all Social Security beneficiaries and almost half of all single participants in the program, many of whom are elderly widows.”
***Some Progressive Centrists Disagree that a hard-line stance on the left against entitlement cuts is prudent. Respected Brookings Institution scholar Henry J. Aaron writes in the latest issue of Democracy: A Journal of Ideas (Progressives and the Safety Net) that “while reports of a crisis are overblown, and conservative proposals to solve it are draconian, progressives do need to think about how best to reform the entitlement programs.” He adds, “It behooves supporters of social insurance to have in reserve program cuts that would do the least harm and might advance other meritorious objectives.”
Apart from the policy debate, though, a portion of Aaron’s democratic discussion caught my attention. Citing Stanford health economists Karen Eggleston and Victor Fuchs in the Journal of Economic Perspectives, he noted, “Only 40 percent of babies born in 1900 lived to age 65. Mortality before child-bearing age explains why high birth rates led to little or no population growth. In the early and mid-20th century, that changed. Major public health and medical advances-notably, improved sanitation and diet, and antibiotics-caused mortality from infectious diseases to plummet. Now, more than 80 percent of babies are expected to live to age 65. As mortality rates for young adults approach zero, most longevity gains have to occur among the old . . . . The share of longevity gains among those over age 65 has risen from one-fifth at the start of the 20th century to 80 percent now, and the share is rising.”
That is, a century ago, only six in 10 people born made it to 65, but today eight in 10 do so. Aaron goes on to summarize the disturbing recent MacArthur Foundation report showing “that most longevity gains have accrued to the well educated. Those with little education are actually dying younger than they were in the past. A pre-existing longevity gap is expanding with alarming speed. Between 1990 and 2008, life expectancy at age 25 among white men and women with less than a high-school education fell 3.3 years and 5.3 years, respectively.” Aside from lower-educated white, all other demographic groups made gains in longevity over the 20 years of the study data-but educated whites still made significantly greater gains in life expectancy that other racial and ethnic groups.
4. CALENDAR 2013
Off the Cliff with a Parachute: Two January meetings by the National Academy of Social Insurance (NASI) in Washington, D.C., will present some of the top experts across the entitlements-debate spectrum.
*** “Strengthening Social Security: What Americans Want,” will be held at the National Press Club, January 15 8:30 a.m.-noon Eastern. NASI and the MetLife Mature Market Institute will release a joint study examining the needs and preferences of the nation’s increasingly aging and diverse population. Speakers will range from Norman Ornstein, Resident Scholar, American Enterprise Institute, to Maya Rockeymoore, president and CEO, Global Policy Solutions (former policy and research director of the Congressional Black Caucus).
*** “Medicare and Social Security in a Time of Budget Austerity,” also at the NPF, Jan. 31 and Feb. 1, 2013. The event, NASI’s 25th Annual Policy Research Conference, will include among many speakers, a keynote by David Wessel, of the Wall Street Journal and NPR, and a diner keynote session with E.J. Dionne, Jr., of the Brookings Institution and Washington Post, who will lead a discussion with top pollsters, such Anna Greenberg, Senior Vice President at Greenberg Quinlan Rosner Research, on “How Can We Get Consensus on Medicare and Social Security Reforms After the Heated Political Campaigns?”
Reporters can request a media pass from NASI’s Jill Braunstein, 202-452-8097; jillbraun@nasi.org. Click to view the full program and speaker line-up.
5. STIRRING THE RESEARCH POT
Pregnancies, Aging and Disability: A study published in the December 2012 American Journal of Public Health comes to the disturbing conclusion that having too many pregnancies may so weaken a woman’s ability to stand or walk in old age having multiple children tends to be a health hazard for them, such as by placing them at greater risk for falls.
Researchers Abigail R. A. Aiken and Jacqueline L. Angel of the Lyndon B. Johnson School of Public Affairs and the Population Research Center, University of Texas, Austin, and Toni P. Miles, director of the Institute of Gerontology, University of Georgia, Athens, analyzed extensive data from the H-EPESE epidemiologic data base for Hispanic elders (Mexican Americans) ages 65 and older in five Southwestern states. The also tested many in person for the time it took them to rise from a chair and walk 10 feet, a standard performance-oriented mobility assessments. They found that almost half of women who’d had six or more pregnancies (44.9 percent) experienced ambulatory limitations, compared with about one in four of those who’d had four or fewer pregnancies (27%). So for the first time they exposed multiple pregnancies as a risk factor for disability and falls in later life.
The authors note, “In a recent U.S. population health survey, women aged 65 years and older were almost 20 percent more likely than were men to experience walking difficulty, a fact reflected in their rates of fractures and joint problems.”
They explain that they focused on Mexican Americans, the largest Hispanic ethnic group in the United States, because of the so-called Hispanic paradox. Latinos live longer than whites (by 2.5 years on average) and African Americans by 7.7 years, but they, especially Hispanic women, live those extra years with greater illness and disability.
Along with their epidemiological recommendations, the study says that “policies designed to increase access to effective, affordable methods of contraception for Hispanic women of all income levels and immigration statuses (a particular problem in states such as Texas at present) may have the potential to delay ambulatory limitation in old age.
They also suggest that older mothers who had many pregnancies “might be advised about pelvic floor exercises or other lower body muscle strengthening regimens to lower the risk of ambulatory limitation in later life.” And the authors observe that clinicians might find helpful tips on this from a surprising sources-the emerging medical sports literature for helping bicycle racers. Evidently, they commonly suffer from similar pelvic injuries. Who knew?
Journalists can request a PDF of this study, titled “Pregnancy as a Risk Factor for Ambulatory Limitation in Later Life,” (December 2012) from APHA’s Audrey Pernik –Office: 202-777-2509, Cell: 202-297-8820′ e-mail: audrey.pernik@apha.org. And contact Jacqueline Angel at jangel@austin.utexas.edu, or Toni Miles at tonimile@uga.edu.
*** States Shifting of Medicaid Long-Term Support/Services to Manage Care: Former Boston Globe reporter on health and aging, Alice Dembner turned up a couple of weeks ago on the advocacy side, but with the same hard-nosed reporting as ever. She scribed a revealing report for the nonprofit Community Catalyst, where she now works, and on a topic many generations beat reporters should be scrutinizing closely. Both blue and red states have been rushing toward converting their long-term care programs (under the latest term of jargon, long-term care support and services, or LTSS, to managed care.
Dembner’s report, titled Putting Consumers First: Promising Practices for Medicaid Managed Long-Term Services and Supports, should help reporters who are grappling with this complicated but big-impact story on seniors get a handle on who is doing what and what questions to ask. She describes the potential benefits of what had been a very fragmented system for decades, such as actually providing comprehensive, coordinated care to frail seniors and people with disabilities.
Dembner’s analysis pointed to which states were exception; (major among them, Wisconsin, long a leader on community based care), and strikingly crass and uncaring. But the report metes out both praise and criticism on a bipartisan basis. And its warnings need to be heeded and the basis for reports across the country as state governments lay claim to managed care as a panacea for the ills of a long neglected realm of health care.
If your state is one of the roughly half of the stars on the American flag turning to LTSS managed care for it most vulnerable citizens, you’ll find Dembner’s national context a boon to your coverage. But you’ll still need a more focused examination of your state’s approach. In California, the SCAN Foundation just released a report on its September LTSS “summit” bringing together major stakeholders around Gov. Jerry Brown’s rocky effort so far to force LTSS programs – such as adult day health care, case management and home care, into a managed care model.
Although the report is cloaked I a foundation’s diplomatic tone of gentility, GBO was pleased to find it also includes candid reflection of the underlying tone of criticism by many advocates and direct providers that we witnessed at the conference. More importantly, reporters covering federal-state financed programs, especially those for people dually eligible for Medicare and Medicaid, will find this an important companion piece to the Community Catalyst national overview.
Click here to find this report online.