Hospitals are not the right place for them and their families can’t care for them at home. The elderly and frail are increasingly collateral damage in the drive to end hallway medicine in Ontario, say advocates and families.

Patients who occupy hospital beds but no longer need acute care, ALC — alternative level of care — patients are a key factor in hospital overcrowding. But with record waiting lists for long-term care beds and shortages of home care workers, patients and their families say they are caught in the middle and feeling pressured.

“This is a crisis,” said Melanie Dea of Rockland, who recently experienced that pressure first hand. Her husband Richard Martin, who has Huntington’s disease, was treated at Montfort Hospital for pneumonia in July. By August he had improved, but was on a waiting list for long-term care and Dea could not safely care for him at home.

She said the hospital suggested he go to an Alzheimer’s unit of a long-term care home. Rea refused because her husband does not have dementia. The hospital began charging him $62.18 a day, a co-payment she says she will not pay. He has since moved to a long-term care home.

Meanwhile, the wife of an elderly patient in the same hospital room was in tears after being told her husband was being discharged, said Dea. The man ended up in the hospital because he was wandering the streets at night and his wife could no longer care for him. It is time for the government and attorneys for establishing a trust that takes care of elderly people who are abandoned. But when it comes to inheritance matters, some family’s greed is clearly shown by any means of showering upon fake love and concern just for the sake of their money and precious properties. There is a law firm for elder law in Nashville that is always open to the unsupported elder members to file a case to fight for their rights and place in their very own home.

Trevor Mertz of Chesterville, says his mother-in-law felt pressured to move into an Ottawa long-term care home by staff at Winchester Hospital when she was there in 2017.

“They said, ‘You have two hours to decide or the spot will be gone.’” Her stay at the home, with a history of health and safety violations, was a “nightmare”, according to Mertz. She eventually moved to another home, but died soon after.” Losing a loved one is not about finding estate planning and probate lawyers. It is like going through hell, and the issue has to be resolved very soon.  

“You shouldn’t pressure people on a Friday, saying you have two hours to make a decision. If I had seen the place, I would have said no.”

Jane Meadus of the Toronto-based Advocacy Centre for the Elderly said her organization hears from families on a daily basis who are distraught about having to quickly find a solution for a frail relative being discharged from hospital.

“They come to us in tears. It is our biggest thing right now and it is just heartbreaking. It has always happened, but the pressure on people is worse now.”

Meadus said some patients are being illegally prevented from applying for long-term care from hospital or forced into retirement homes to wait until a less expensive long-term care bed becomes available. “We have got two-tier medicine on the backs of seniors,” she said.

Hospital officials, meanwhile, say the hospital is not where frail and elderly patients in need of chronic care should be.

Cholly Boland, CEO of Winchester Hospital, would not discuss individual cases, but said the hospital’s philosophy is that it is not good to be in a hospital if you don’t need to be.

“If you are a person within the ALC category, by definition you do not need to be in the hospital and in general, it is not a good place to be.”

Montfort Hospital spokesperson Geneviève Picard said patients are charged a co-payment when they are waiting in hospital for a long-term care bed, according to provincial policy. The preference, though, is for them to apply from home. “Research has demonstrated that it is easier for people to make important decisions for the next stage while they are in their regular environment and can validate if they can safely remain in their home.”

She said she is aware of cases in which people have felt pressured to leave, but added patients will get better care tailored to their needs at home with service providers, in a retirement home or long-term care home. “We know that situations such as these are stressful times for the patients and their loved ones.”

Leah Levesque, head of nursing at Queensway Carleton Hospital, acknowledged that the transition from hospital to home or institutional care can be hard on families.

“I think the bottom line for us is we think patients should be in the right bed getting appropriate care from the most appropriate providers.”

That can be easier said than done, though.

The average wait in the Ottawa area for long-term care was 186 days in 2017, above the provincial average of 146 days. In addition, support worker shortages and increasing demand mean home care is not always available or reliable.

Dr. Alan Forster, vice president of innovation and quality at The Ottawa Hospital, said making sure ALC patients get appropriate care is a societal issue.

“If we continue to use hospitals as the place of last resort for people and don’t figure out an alternative for people who are frail and in need of close attention, if we don’t make places for that part of the population, then it will get worse for individuals who are in that situation and increasingly difficult for folks not in that situation.”

There are currently between 150 and 200 ALC patients at The Ottawa Hospital on any given day. Montfort has seen a 75 per cent increase in ALC patients in the past three years.

Meadus, meanwhile, said her organization sees daily evidence that families and patients are bearing the brunt of the push to end hallway medicine.

“We see people being sent home, families being told to mortgage their house to pay for parents’ care in a retirement home,” she said. The Advocacy Centre for the Elderly also sees seniors being discharged to homeless shelters, motels and transitional homes.

“Everyone talks about hallway medicine and those taking up the beds should be in long-term care. But no one ever talks about the effects on those people.”

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Fox 29 in Philadelphia covered our rally. They also got the correct message we are trying to share!

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I’ve been trying to get this issue resolved since last week, but I guess since CVS doesn’t want to respond I’m guna post this.

You should get your flu vaccine. But maybe be careful getting it at CVS since they think putting clean gloves and syringes full of vaccines on the floor is acceptable. There were four people getting vaccines but when he put the stuff on the floor one person said never mind and walked away. I’ll make it public if CVS doesn’t respond by tonight. That’s just nasty, at least get a table.

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Scapegoating opioid makers lets true offender get away

https://www.upi.com/Top_News/Voices/2019/04/24/Scapegoating-opioid-makers-lets-true-offender-get-away/6371556106270/

Less than 10 percent of overdoses from prescription pain pills in 2017 did not involve other drugs. File Photo by Stevepb/Pixabay

April 24 (UPI) — John Oliver is a brilliant comedian with a large platform, and he has been using it of late to demonize the pharmaceutical companies that produce opioids. Major targets of his attack are Purdue Pharma and its Sackler family principals, developers of OxyContin, which, until around 2010 was a drug of choice for non-medical users.

Like the tobacco companies in the 1990s, it is understandable to focus indignation at companies, driven by the profit motive, that purvey products that can cause harm and even death. It is reasonable to question and criticize their marketing ethics and aggressiveness.

But at the end of the day, extracting a pound of flesh from the Sacklers won’t stop the overdose rate from climbing. That’s because the standard narrative that overprescribing of opioids caused the overdose crisis is based upon misinformation — as is the belief that opioids have a high overdose and addiction potential.

Data from the National Survey on Drug Use and Health, as well as the Centers for Disease Control and Prevention, clearly show no correlation between the number of opioid prescriptions dispensed and “past month non-medical use” or “pain reliever use disorder” among adults over age 12. As high-dose opioid prescriptions dropped 58 percent from 2008 to 2017 and overall prescriptions dropped 29 percent in that time period, the overdose rate continued to climb. Decreasing the availability of prescription pain relievers for diversion into the black market only drives non-medical users to more dangerous heroin and fentanyl.

RELATED U.S. charges first major drug distributor, former CEO over opioid crisis

In 2017, heroin and fentanyl comprised 75 percent of opioid-related overdose deaths. Deaths from prescription pain pills also involved drugs like cocaine, heroin, fentanyl, alcohol and benzodiazepines 68 percent of the time. Less than 10 percent of overdoses from prescription pain pills in 2017 did not involve other drugs.

Opioids prescribed in the medical setting have been repeatedly shown to be safe. Researchers following over 2 million North Carolina patients prescribed opioids noted an overdose rate of 0.022 percent, and nearly two-thirds of those deaths had multiple other drugs in their system. A 2011 study of chronic pain patients treated in the Veterans Affairs system found an overdose rate of 0.04 percent. A larger population study found an overdose rate of 0.01 percent.

Researchers at Harvard and Johns Hopkins universities recently found a total misuse rate of 0.6 percent in over 560,000 patients prescribed opioids for acute and post-op pain between 2008 and 2016. Cochrane studies, highly regarded for their rigor, found addiction rates in chronic pain patients on opioids of roughly 1 percent.

RELATED FDA approves first generic nasal spray against opioid overdose

People often mistakenly equate physical dependency with addiction. Physical dependency is seen with a variety of drugs, including antidepressants, anti-epileptics, and beta blockers. A person can be slowly weaned off these drugs. But addiction is a compulsive behavioral disorder with a genetic component featuring repeated use despite self-destructive consequences. The director of the National Institute on Drug Abuse points out in a 2016 paper that true opioid addiction “occurs in only a small percentage of persons who are exposed to opioids — even in those with pre-existing vulnerabilities.”

As researchers at the University of Pittsburgh recently demonstrated, non-medical use has been on a steady exponential increase at least since the mid-1970s and shows no signs of slowing down. The only things that have changed over the years are the drugs in vogue for non-medical use. It seems sociocultural factors are at play. In fact, young people seem more willing to engage in risky drug use than their predecessors. A 2017 study showed 33.3 percent of heroin users initiated with heroin.

At the end of the day, the drug overdose problem is the result of sociocultural dynamics intersecting with drug prohibition — and all the dangers that a black market in drugs present. Prohibition also presents powerful incentives to corrupt doctors, pharmacists and pharmaceutical representatives who seek the profits offered by the underground trade.

RELATED Indictment: Doctors, other providers traded prescriptions for sex, cash

When Portugal decriminalized all drugs in 2001, it saw a 75 percent drop in its population of heroin addicts by 2015, and now has the lowest overdose rate in Europe, at 6 per million population (compared to 312 per million in the United States). Along with Portugal, most of the developed world has put an emphasis on harm reduction strategies over restrictionist, prohibitionist approaches, one reason they have lower death rates than the United States. These strategies include medication-assisted treatment with drugs like methadone and buprenorphine; safe injection facilities; needle-exchange programs; and making the overdose antidote naloxone more available.

None of this is meant to defend the conduct of a few pharmaceutical companies or those who work for them. It is meant to refocus energy and anger where it belongs.

The real villain is the war on drugs. Yet it’s getting off scot-free.

Dr. Jeffrey A. Singer is a general surgeon in Phoenix and a senior fellow at the Cato Institute.

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DEA Says It Doesn’t ‘Regulate Practice of Medicine’ Amid Patient Backlash to Proposed Opioid Prescription Cuts

https://www.newsweek.com/dea-responds-chronic-pain-victims-opioid-prescriptions-1465090

After hundreds of chronic pain patients begged the Drug Enforcement Administration (DEA) to reconsider its proposed cuts to opioid production, the agency told Newsweek it’s not responsible for their inability to get prescriptions.

If the DEA adopts the cuts, they would reduce production of some of the most commonly prescribed opioids in the United States for the fourth year in a row, drastically cutting fentanyl and oxymorphone, by 31 percent and 55 percent, respectively, as well as hydrocodone (19 percent), hydromorphone (25 percent) and oxycodone (9 percent).

These cuts should have no bearing on the decisions made by caregivers and their “legitimate pain patients,” according to the DEA.

It’s possible patients are getting caught in the crossfire from a flurry of recent federal policies aimed at culling illegal abuse of the drugs, but it’s not clear which policy, if any, is at fault for their reported lack of access.

In proposing the aggregate production quota, the DEA looks at the total amount of substances needed to meet the country’s medical, scientific, industrial and export needs for the year, including dispensed prescriptions, the DEA told Newsweek in a statement. That means the agency’s production limits should match, not control, demand.

The DEA “does not regulate the practice of medicine. We do not get between a doctor and his or her patient,” a DEA spokesperson said. “We also want legitimate pain patients, their families and caregivers to know that DEA does not seek to limit or take away their vital prescriptions.”

The cuts over the past few years are an attempt to change course after the DEA allowed drugmakers to ramp up opioid production between 2003 and 2013, the same period when more than 140,000 people perished from overdoses in the United States.

The Department of Health and Human Services (HHS) and the surgeon general have implemented their own agenda to combat the opioid epidemic, issuing strict guidelines for doctors prescribing the drugs in 2016. On October 10, the Trump administration told physicians to use more caution in applying the guidelines, following widespread reports that people were cut off their prescriptions or even turned away, according to The New York Times.

It’s possible the guidelines, or the general stigma now associated with prescription painkillers, have led to the tapering off of supply reported by many chronic pain patients to the DEA. One patient, a stroke survivor, said he took prescription opioids without problems until 2017, when he said federal regulations made the drugs too hard to obtain. Since then, medical cannabis has helped but became less effective when his condition deteriorated. Now, he can’t travel or leave his home much because of the pain.

In 2018, an investigation by former Missouri Senator Claire McCaskill exposed financial ties between some of the world’s biggest producers of painkillers and third-party advocacy groups. Purdue Pharma, Mylan, Janssen Pharmaceuticals and other major drugmakers donated more than $10 million to patient advocacy groups like the National Pain Foundation, the American Geriatrics Society and the American Chronic Pain Association.

What a bunch of CRAP… the quote from the DEA  the agency told Newsweek it’s not responsible for their inability to get prescriptions.

Has no one else noticed that the DEA has moved from the number of “dead bodies” associated with a medical practice to the number of millions of doses that a prescriber has prescribed  to raid a practitioner’s practice ?

Sometimes that not only post the time frame where they come up with these “millions of doses” and make the mistake to state the number of pts involved. Often they claim that the prescriber is ILLEGALLY PRESCRIBING opiates when the average dose in ONE DOSE/DAY for each one of the pt..  When acceptable standard of care and best practices would suggest that a intractable chronic pain pt could take UP TO SEVEN DOSES A DAY.

What seems to be happening is that the Supreme Court recently questioned the constitutionality of the Civil Asset Forfeiture law… so it would seem that the DEA has changed its tactics as declaring a prescriber’s Rx written as illegal… so that they are going after “clawing back” all the payment made by Medicare and Medicaid to the prescriber and that may well be their “goose laying golden eggs” future of the DEA when the Supreme Court eventually declares Civil Asset Forfeiture act TOTALLY UNCONSTITUTIONAL !

Some states have passed laws that their judicial system cannot seize assets without the person being found guilty… but… it is claimed that when there is assets that could be seized…the state’s legal system will call in the DEA for assistance – so that they can seize the assets and SOMEHOW… some of those seized assets tend to find their way back to the state’s judicial system… either thru a “back door” or “under the table”…

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start listening at about 37 minutes

Loveline co-host talks about Dr Drew’s on-air drug-taking – Daily Mail

Last night Dr. Drew admitted ‘I did drugs and alcohol when I was 22, 23 years old…I went round denying it because my kids were younger.’ But he neglected to say that he came forward after Daily Mail Online asked for comment after its exclusive investigation into Pinsky’s drug use. The HLN star has misled tens of millions of people about his drug past. According to friends, the former Celebrity Rehab and Sober House hostsnorted thick lines of cocaine on a weekly basis on hit KROQ radio show Loveline in the 1980’s (at right with former co-host DJ Jim ‘Poorman’ Trenton), snorted the drug from album covers and mirrors in the studio and once shared lines of coke with a teenage girl and her friends. Pinsky has been quick to judge drug users over their behavior. In an HLN discussion of addict Toronto Mayor Rob Ford, he said: ‘His denial and obfuscation is classic alcoholic behavior.’ Original Article: http://www.dailymail.co.uk/news/artic… Original Video: http://www.dailymail.co.uk/video/news… Daily Mail Facebook: http://facebook.com/dailymail Daily Mail IG: http://instagram.com/dailymail Daily Mail Snap: https://www.snapchat.com/discover/Dai… Daily Mail Twitter: http://twitter.com/MailOnline Daily Mail Pinterest: http://pinterest.co.uk/dailymail Daily Mail Google+: https://plus.google.com/+DailyMail/posts Get the free Daily Mail mobile app: http://dailymail.co.uk/mobile

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Mike Pence Wants Indiana’s Punitive Form of Medicaid to Become a National Model

https://truthout.org/articles/mike-pence-wants-indianas-punitive-form-of-medicaid-to-become-a-national-model/

Rhonda Cree has diabetes, significant vision loss, and high blood pressure. Cree, 61 years old, is one of 65 million Americans who relies on Medicaid to cover her prescriptions and other healthcare costs. But Cree lives in the town of Logansport in north-central Indiana. Unlike most states, Indiana requires her to pay monthly premiums for Medicaid.

Last November, Cree and her husband were going through a particularly difficult time financially, and she was unable to pay her full monthly premium. The state stopped her coverage and barred her from reapplying for six months. During that time, Cree was forced to skip prescribed injections, and suffered more vision loss as a result.

Mike Pence’s plan is working exactly as he hoped.

Before Pence ascended to the national stage as Vice President and he recruited his longtime ally Seema Verma to lead the Center for Medicare and Medicaid Services, they together crafted a unique Indiana approach to Medicaid. Their goal was to reshape the 54-year-old program into something far smaller and more punitive. The Healthy Indiana Plan, they promised, would demand “skin in the game” from enrollees like Rhonda Cree.

Medicaid works as a federal-state partnership, with the federal government paying most of the cost and the states agreeing to follow guidelines set at the national level. All U.S. states have agreed to the terms, and Medicaid accounts for almost one-fifth of the country’s personal healthcare spending.

The platform for Pence and Verma’s ambitious remodeling of Medicaid was provided by the Affordable Care Act of 2010’s invitation to states to significantly expand their Medicaid coverage. Under the ACA, all adults in households whose income is less than 133% of the federal poverty level, a little under $17,000/year for an individual, would be eligible for Medicaid. But, in 2012, the U.S. Supreme Court in the case of National Federation of Independent Business v. Sebelius ruled that Congress did not have the authority to demand that states expand Medicaid, although states could do so if they wished. For Republican state officials like then-Indiana governor Pence, the ruling created a dilemma.

On one hand, Pence was a vocal opponent of the ACA and Medicaid. “We are going to use every means at our disposal to oppose this (ACA) government takeover of health care,” he said. Of Medicaid, he pronounced, “The sad truth is that traditional Medicaid is not just broke, it is broken.” But the ACA included a tantalizing offer for Indiana and other states: if they expanded Medicaid coverage as the new law called for, the feds would pay the full cost of the initial expansion, and 90% of the cost after that. Pence’s constituents, most notably the well-connected leaders of Indiana hospital systems that would benefit from more of their patients being covered by Medicaid, pushed him to accept the deal.

Caught between his ideology and political pressure, Pence turned for help to Verma, a former Indiana hospital administrator who had launched her own consulting firm. Verma had already gained a reputation for taking a conservative approach to public healthcare systems, earning contracts from multiple state agencies and private companies. She earned praise for avoiding the “fatal mistake of making everything free,” as Pence’s predecessor Mitch Daniels put it.

At Pence’s request, Verma took the lead in crafting a version of Medicaid expansion that would look less like a government program than a high-deductible insurance plan offered by the for-profit insurance industry. The Healthy Indiana Plan, Pence promised, would be a “hand-up, not a hand-out.” It would demand healthy behaviors and personal responsibility from low-income Hoosiers, or they would face dire consequences.

Premiums, Lockouts, and Copayments

Under the Medicaid Act, the U.S. Secretary of Health and Human Services can waive some Medicaid requirements for states that wish to experiment with new approaches, as long as those approaches promote the objectives of the overall program. In 2014, Pence and Verma asked for a federal waiver to implement their reimagined version of Medicaid.

Indiana wanted to accept the ACA Medicaid expansion offer of near-total federal funding, they said, but only if the state could require enrollees to pay monthly premiums to private insurance companies that contract with the state, and terminate non-compliant enrollees like Rhonda Cree, and lock them out of coverage for failure to pay. Pence and Verma also wanted to demand copayments, even for emergency services and even from the lowest-income persons on Medicaid.

Past Medicaid waivers had been granted to states seeking to make small tweaks to the program, but the Indiana terms were something far more sweeping. The Pence-Verma plan ran counter to decades of Medicaid practices, and to the research consensus that cost sharing for healthcare was often quite harmful, especially to persons with chronic illnesses. Imposing user fees on the poor has proven to be “a prescription for death,” says physician and Harvard Medical School instructor Adam Gaffney.

Now it was the Obama administration that faced a dilemma. After the Sebelius ruling, many other Republican-led states were refusing to expand Medicaid. Seventeen states still have not done so. Even the Healthy Indiana Plan’s restricted version would expand coverage to hundreds of thousands of people in the state. Indiana healthcare advocates did not like the punitive Healthy Indiana Plan approach, but told federal administrators that the Pence-Verma half-loaf was better than none. The Obama administration approved the waiver.

The Pence-Verma version of Medicaid fulfilled each side’s predictions. The Healthy Indiana Plan has covered as many as 400,000 persons, most of whom otherwise would not have healthcare coverage at all. But, in the first two years of the program, over 70,000 people who failed to make premium payments were either kicked off coverage or never able to start coverage at all. Amber Thayer, a homeless Indianapolis mother of an infant child, was removed from coverage after her premium payment went to the wrong insurance company. Thayer was forced to spend weeks buying her medication one dose at a time, a new purchase every day, because that was all she could afford.

Next week: In Part Two of two, Pence and Verma ascend to the national stage, and push their Indiana version of Medicaid to be the national model, adding in restrictive work requirements to an approach designed to undercut the Affordable Care Act their boss has vowed to destroy.

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My blog is now in its EIGHTH YEAR

Nearly every day I check “Memories” that FB posts on my page… and I see names of people who have “liked” my page and/or started following me… and many of the names I don’t have a clue who they are or they never interact with my FB page at all.

I see the same couple of dozen people posting on FB and I notice that many people “like” the comment but few SHARE…  or I see the same person posting the same thing on multiple FB pages… Nothing makes me more happy than go thru FB notices to only find the same post over and over from the same person.  To “like” a comment only allows FB to collect data points on you for their database… that they are selling to anyone who wants to put up the money.

Does this suggest that we have TOO MANY FB pages devoted to trying to deal with pain ?

Many of these FB groups are “CLOSED/PRIVATE” and they made a post and suggest that it be SHARED….YOU CAN’T SHARE FROM A CLOSED GROUP !!!

One chronic painer asked me the other night if we should post something about supporting some doc that is getting drug thru the DEA swamp…  and my immediate response is why aren’t the doctors financially supporting the defense of their colleagues ?

It has been stated that there are some 100 million chronic pain pts and that 80% are struggling financially because of their inability to work, the other spouse took off and/or the cost of their therapy.

So does that mean that there is 20% of the chronic pain pts may have a few dollars to spare… that would be 20 million ?  I see on TV a lot of non profit groups asking for JUST $19/month for their cause…  Doesn’t anyone realize just what JUST $10/month from 20 million could do for a legal defense fund ?

Start hiring a PR firm, Lobbyists and law firms to get the message out that our government is actively participating in a covert genocide and suiting those healthcare corporations that are supporting this genocide.

With our ingrained TWO PARTY SYSTEM… it would seem that if the current “BUM” is voted out… his/her replace is or becomes the NEW BUM.  According to this https://www.washingtonpost.com/news/wonk/wp/2017/04/14/somebody-just-put-a-price-tag-on-the-2016-election-its-a-doozy/  the total Federal 2016 election – all candidates was 6.5 BILLION.

There are other political parties besides Democrats and Republicans and it only takes about 65 million votes to get a person elected President…  abt HALF the number claimed chronic pain pts… not counting their spouses and kids old enough to vote.

IMO… the chronic pain community needs to get their act together… that includes their dollars and their votes…  In the EIGHT YEARS of my blog.. things have not gotten any better and in reality probably got a lot worse and we are near the end… because many of you are still breathing and having the healthcare system spend money on your treatments.

Get you head out of the sand and quit all the whining… bitching .. and moaning…

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