Scientists: Brain injuries from war worse than thought
Scientists trying to understand traumatic brain injury from bomb blasts are finding the wound more insidious than they once thought.
They find that even when there are no outward signs of injury from the blast, cells deep within the brain can be altered, their metabolism changed, causing them to die, says Geoff Ling, an advance-research scientist with the Pentagon.
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This cellular death leads to symptoms that may not surface for months or years, Cernak says. The symptoms can include memory deficit, headaches, vertigo, anxiety and apathy or lethargy. "These soldiers could have hidden injuries with long-term consequences," he says.
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To make matters worse, whatever damage occurred was so microscopic that it could not be found with imaging tests.
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The microscopic damage changes brain cell metabolism, Cernak says, creating a cascading effect that leads to the premature aging and death of neurons that cannot be replaced. ...
Sunday, September 30, 2007
Sunday, September 23, 2007
More Profit and Less Nursing at Many Homes ... serious health deficiencies ... almost 19 percent higher at homes owned by large investment companies
More Profit and Less Nursing at Many Homes | By CHARLES DUHIGG | Published: September 23, 2007
Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.
The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.
The investors and operators were soon earning millions of dollars a year from their 49 homes.
Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.
“They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.
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The typical nursing home acquired by a large investment company before 2006 scored worse than national rates in 12 of 14 indicators that regulators use to track ailments of long-term residents. Those ailments include bedsores and easily preventable infections, as well as the need to be restrained. Before they were acquired by private investors, many of those homes scored at or above national averages in similar measurements.
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The Byzantine structures established at homes owned by private investment firms also make it harder for regulators to know if one company is responsible for multiple centers. And the structures help managers bypass rules that require them to report when they, in effect, pay themselves from programs like Medicare and Medicaid.
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Some families of residents say those structures unjustly protect investors who profit while care declines.
When Mrs. Hewitt sued Habana over her mother’s death, for example, she found that its owners and managers had spread control of Habana among 15 companies and five layers of firms.
As a result, Mrs. Hewitt’s lawyer, like many others confronting privately owned homes, has been unable to establish definitively who was responsible for her mother’s care. ...
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But in recent years, large private investment groups have agreed to buy 6 of the nation’s 10 largest nursing home chains, containing over 141,000 beds, or 9 percent of the nation’s total. Private investment groups own at least another 60,000 beds at smaller chains and are expected to acquire many more companies as firms come under shareholder pressure to sell.
The typical large chain owned by an investment company in 2005 earned $1,700 a resident, according to reports filed by the facilities. Those homes, on average, were 41 percent more profitable than the average facility.
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The Times’s analysis of records collected by the Centers for Medicare and Medicaid Services reveals that at 60 percent of homes bought by large private equity groups from 2000 to 2006, managers have cut the number of clinical registered nurses, sometimes far below levels required by law. (At 19 percent of those homes, staffing has remained relatively constant, though often below national averages. At 21 percent, staffing rose significantly, though even those homes were typically below national averages.) During that period, staffing at many of the nation’s other homes has fallen much less or grown
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The typical number of serious health deficiencies cited by regulators last year was almost 19 percent higher at homes owned by large investment companies than the national average, according to analysis of Centers for Medicare and Medicaid Services records. ..
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September 22, 2007 | Layers of Ownership
Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.
The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.
The investors and operators were soon earning millions of dollars a year from their 49 homes.
Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.
“They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.
...
The typical nursing home acquired by a large investment company before 2006 scored worse than national rates in 12 of 14 indicators that regulators use to track ailments of long-term residents. Those ailments include bedsores and easily preventable infections, as well as the need to be restrained. Before they were acquired by private investors, many of those homes scored at or above national averages in similar measurements.
...
The Byzantine structures established at homes owned by private investment firms also make it harder for regulators to know if one company is responsible for multiple centers. And the structures help managers bypass rules that require them to report when they, in effect, pay themselves from programs like Medicare and Medicaid.
...
Some families of residents say those structures unjustly protect investors who profit while care declines.
When Mrs. Hewitt sued Habana over her mother’s death, for example, she found that its owners and managers had spread control of Habana among 15 companies and five layers of firms.
As a result, Mrs. Hewitt’s lawyer, like many others confronting privately owned homes, has been unable to establish definitively who was responsible for her mother’s care. ...
...
But in recent years, large private investment groups have agreed to buy 6 of the nation’s 10 largest nursing home chains, containing over 141,000 beds, or 9 percent of the nation’s total. Private investment groups own at least another 60,000 beds at smaller chains and are expected to acquire many more companies as firms come under shareholder pressure to sell.
The typical large chain owned by an investment company in 2005 earned $1,700 a resident, according to reports filed by the facilities. Those homes, on average, were 41 percent more profitable than the average facility.
...
The Times’s analysis of records collected by the Centers for Medicare and Medicaid Services reveals that at 60 percent of homes bought by large private equity groups from 2000 to 2006, managers have cut the number of clinical registered nurses, sometimes far below levels required by law. (At 19 percent of those homes, staffing has remained relatively constant, though often below national averages. At 21 percent, staffing rose significantly, though even those homes were typically below national averages.) During that period, staffing at many of the nation’s other homes has fallen much less or grown
...
The typical number of serious health deficiencies cited by regulators last year was almost 19 percent higher at homes owned by large investment companies than the national average, according to analysis of Centers for Medicare and Medicaid Services records. ..
====================================
September 22, 2007 | Layers of Ownership
Saturday, September 22, 2007
Bush renews threat to veto children’s health legislation: SCHIP deal would raise cigarette taxes by 61 cents per pack to pay for expanded coverage
Bush renews threat to veto children’s health legislation | By Elana Schor | September 21, 2007
As negotiators closed in on a $35 billion deal to extend health insurance coverage for children, President Bush defied lawmakers with a fresh threat to veto the bipartisan bill that aggravated one senior Senate Republican.
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Sen. Chuck Grassley (Iowa), senior Republican on the Finance Committee, had implored Bush to reconsider his veto vow. But after Bush incorrectly described the children’s health bill as providing coverage for families earning up to $80,000 a year, Grassley fired back.
“The president’s understanding of our bill is wrong,” Grassley said, his voice rising with anger. “I urge him to reconsider his veto message based on a bill we might pass, not something someone on his staff told him wrongly is in my bill.”
The SCHIP deal would raise cigarette taxes by 61 cents per pack to pay for expanded health coverage while taking aim at a Bush administration directive that would restrict states’ ability to raise income eligibility levels for the program. ...
As negotiators closed in on a $35 billion deal to extend health insurance coverage for children, President Bush defied lawmakers with a fresh threat to veto the bipartisan bill that aggravated one senior Senate Republican.
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Sen. Chuck Grassley (Iowa), senior Republican on the Finance Committee, had implored Bush to reconsider his veto vow. But after Bush incorrectly described the children’s health bill as providing coverage for families earning up to $80,000 a year, Grassley fired back.
“The president’s understanding of our bill is wrong,” Grassley said, his voice rising with anger. “I urge him to reconsider his veto message based on a bill we might pass, not something someone on his staff told him wrongly is in my bill.”
The SCHIP deal would raise cigarette taxes by 61 cents per pack to pay for expanded health coverage while taking aim at a Bush administration directive that would restrict states’ ability to raise income eligibility levels for the program. ...
Emergency Care Is Limited by U.S. Rule ... Bush administration ... increasingly denying state claims for federal payment for some emergency services
Immigrants’ Emergency Care Is Limited by U.S. Rule | By SARAH KERSHAW | Published: September 22, 2007
The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined. ...
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Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said. ...
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... Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment. ...
The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined. ...
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Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said. ...
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... Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment. ...
Friday, September 14, 2007
no rational reason for the rising costs, and that there are huge disparities across the country ... $11,352 in Miami, #4,273 in Oregon
Expensive and divisive: how America is losing patience with a failing system | Suzanne Goldenberg in Washington | Thursday September 13, 2007 | The Guardian
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Between the two extremes is where America's healthcare system has unravelled. A patchwork of employer benefits and government assistance for the very poor and elderly has produced distinct differences. Those with very good jobs and generous benefits packages enjoy extensive, often almost wasteful, health cover. Meanwhile, tens of millions regularly put their health on hold because they cannot afford basic treatment, prescriptions, or even a visit to the doctor.
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The US spends about 16% of GDP on healthcare, a proportion expected to climb to 20% by 2015, according to the National Coalition on Health Care. At present spending levels of $1.6 trillion a year, which works out at $6,700 per capita, is double what is spent in countries such as France. And yet that still leaves some 47 million Americans entirely without health coverage, and tens of millions of others under-insured, according to latest census figures.
It also fails to guarantee a better service to those Americans with access to healthcare. The US ranks last or near the bottom on quality, access, efficiency, equity and healthy lives, according to a report in May 2007 from the Commonwealth Fund, which studies healthcare.
"The US healthcare system is considered a dysfunctional mess," writes Ezekial Emanuel, chairman of the department of clinical bioethics, in a recent issue of the Journal of the American Medical Association.
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Healthcare experts say that there is sometimes no rational reason for the rising costs, and that there are huge disparities across the country. In Miami, for example, it will cost $11,352 a year to treat the average pensioner, but just $4,273 to treat one in Salem, Oregon, says the Dartmouth Atlas of Health Care. The cost of dying also varies from hospital to hospital, and state to state, the study found.
...
Between the two extremes is where America's healthcare system has unravelled. A patchwork of employer benefits and government assistance for the very poor and elderly has produced distinct differences. Those with very good jobs and generous benefits packages enjoy extensive, often almost wasteful, health cover. Meanwhile, tens of millions regularly put their health on hold because they cannot afford basic treatment, prescriptions, or even a visit to the doctor.
...
The US spends about 16% of GDP on healthcare, a proportion expected to climb to 20% by 2015, according to the National Coalition on Health Care. At present spending levels of $1.6 trillion a year, which works out at $6,700 per capita, is double what is spent in countries such as France. And yet that still leaves some 47 million Americans entirely without health coverage, and tens of millions of others under-insured, according to latest census figures.
It also fails to guarantee a better service to those Americans with access to healthcare. The US ranks last or near the bottom on quality, access, efficiency, equity and healthy lives, according to a report in May 2007 from the Commonwealth Fund, which studies healthcare.
"The US healthcare system is considered a dysfunctional mess," writes Ezekial Emanuel, chairman of the department of clinical bioethics, in a recent issue of the Journal of the American Medical Association.
...
Healthcare experts say that there is sometimes no rational reason for the rising costs, and that there are huge disparities across the country. In Miami, for example, it will cost $11,352 a year to treat the average pensioner, but just $4,273 to treat one in Salem, Oregon, says the Dartmouth Atlas of Health Care. The cost of dying also varies from hospital to hospital, and state to state, the study found.
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