Ann Marie Marciarille
This is a good article but, no, I don’t think we need to “rethink” nursing homes.
Rather, we need to think hard about nursing homes, possibly for the first time. Hardly anybody, now, gets the time and luxury of thinking before they put a family member in a nursing home. It is done in panic mode and, often enough, as part of the reign of terror known as “hospital discharge.”
There are lots of reasons given by the legislators quoted in this article for fighting the people’s will on Missouri Medicaid Expansion, but surely the most troubling is the insistence that it must be opposed because the voters in the person’s district opposed it. Oh, is that how it works?
Bottom line: buildings lacking air control systems designed for infection control are problematic if both individual and collective efforts to limit transmission are not considered.
This article suggests this difficulty in talking about the need to improve indoor ventilation may be because of its complexity. I think there is something else going on: easy to put COVID-19 preventive measures on the person (wash hands; stay distant; wear a mask; pursue vaccination) but harder to talk about measures that may well have to be addressed by others. After all, who will pay for all that increased better indoor ventilation in our schools and workplaces?
Maryland has long led the way with its all payor hospital payment system. This approach has not proven to be easily replicable elsewhere, however.
Now, New York tiptoes in to the area of medical-loss ratios or profitability caps for nursing homes. This should be interesting to watch.
The COVID-19-induced scrutiny of for profit nursing homes and their return on investment numbers might be worth expanding to other kinds of health care providers or venues.
Thanks to KFF, we now have some insight into what has happened to the medical-loss ratio in 2021. The short answer is that health care utilization, overall, is way down, so rebates for 2020 failure to achieve the medical-loss ration will be the order of the day for covered plans.
The even more interesting question is whether this trend will continue into 2021. After all, the pandemic is not quite yet history, recent legislation has extended ACA open enrollment and a whole lot more:
What a time to be an actuary or a forecaster!
There is an excellent article in The Atlantic on this topic. I have to wonder, when the breakthroughs become more widespread, as they inevitably will once COVID-19 vaccination becomes more widespread, if people will start to realize that other vaccinations (measles, mumps, etc.) also leave a certain number of people vulnerable even after vaccination and that degree of risk is variable for each individual. Will this help to dampen vaccination-resistance or enhance it?
True mass vaccination for COVID-19 appears to be upon us. No time like the present to consider whether vaccine-related injury from COVID-19 vaccinations should be added to the list of covered vaccinations for the Vaccine Injury Compensation Program. Make no mistake, the jockeying for position on whether COVID_19 vaccination-related injury should be covered began several months ago, especially over the inclusion of what are arguably vaccine administration (injury from improper administration, often from improper injection site thought to be too high on the arm or shoulder) should be included. Need something else to be worried about? I nominate this.
Or, so you would think. But the numbers are even worse elsewhere. As Dorothy Gale noted: “My, People come and go so quickly here!”
How can it be possible to provide quality care in such circumstances? How can it be possible to vaccinate all willing staff against COVID-19 in such circumstances?
