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By DAVE COLLINS, Associated Press Writer – Sun Oct 4, 3:14 pm ET
HARTFORD, Conn. – The nation’s nursing homes are perilously close to laying off workers, cutting services — possibly even closing — because of a perfect storm wallop from the recession and deep federal and state government spending cuts, industry experts say.
A Medicare rate adjustment that cuts an estimated $16 billion in nursing home funding over the next 10 years was enacted at week’s end by the federal Centers for Medicare and Medicaid Services — on top of state-level cuts or flat-funding that already had the industry reeling.
And Congress is debating slashing billions more in Medicare funding as part of health care reform.
Add it all up, and the nursing home industry is headed for a crisis, industry officials say.
“We can foresee the possibility of nursing homes having to close their doors,” said David Hebert, a senior vice president at the American Health Care Association. “I certainly foresee that we’ll have to let staff go.”
The funding crisis comes as the nation’s baby boomers age ever closer toward needing nursing home care. The nation’s 16,000 nursing homes housed 1.85 million people last year, up from 1.79 million in 2007, U.S. Census Bureau figures show.
Already this year, 24 states have cut funding for nursing home care and other health services needed by low-income people who are elderly or disabled, according to the Center on Budget and Policy Priorities, a nonprofit research firm based in Washington, D.C.
Some facilities are now closed because of money problems — including four in Connecticut — and others have laid off workers because of what industry officials say are inadequate Medicaid reimbursement rates. Medicare cuts are troubling, they say, because the higher Medicare reimbursements have been used to compensate for the lower Medicaid rates.
In Griswold, Conn., the community’s only nursing home shut down earlier this year because of rising costs and an inability to pay for $4.9 million in needed renovations for the 90-bed facility.
“A 92-year-old woman was screaming and crying as she was loaded into the ambulance, saying ‘This is my home,’” Griswold First Selectman Philip Anthony said. His 88-year-old mother was a resident of the same home at the time.
Anthony sought and found a new facility for his mother, but she died of pneumonia before the Griswold Health and Rehabilitation Center closed in the spring.
“To be hit with a sudden and deliberate closure like this, it just drained the heart right out of you,” Anthony said.
Connecticut Gov. M. Jodi Rell and state lawmakers gave no Medicaid rate increases to nursing homes in the state last fiscal year and kept the funding flat for the next two years.
The Griswold home was one of four nursing homes in the state that have closed since December because of financial problems, a higher rate than usual, said Deborah Chernoff, a spokeswoman for District 1199 of the New England Health Care Employees Union in Connecticut, which represents more than 20,000 health care workers in the state.
“We’re really teetering on the edge of what we see as the collapse of the long-term care system,” she said.
Chernoff said many of Connecticut’s 240 or so nursing homes have been reducing workers’ hours to deal with money problems, while two are in bankruptcy now.
Also this year across the country:
• The Motion Picture & Television Fund said in January it would close a hospital and nursing home in Woodland Hills, Calif., founded to care for actors and other entertainment industry workers, because of financial losses.
• The Westchester Medical Center in suburban New York said it would close a nursing home and cut 400 jobs to deal with Medicaid and other fund cuts.
• The Dove Health Care nursing home in Glendale, Wis., near Milwaukee, closed this summer because of heavy debt.
• Medicaid reimbursement rates to nursing homes were cut this year by Rhode Island (5 percent); Michigan (4 percent) and Florida (3 percent).
• Washington state legislators whacked nursing home funding by $93 million for the next two fiscal years.
Gary Weeks, executive director of the Washington Health Care Association, said some of the organization’s 400 assisted living and nursing homes have laid off workers. Some will not survive, he said.
At the request of Weeks’ association, a federal judge in July issued a temporary restraining order blocking the cuts because state officials didn’t do a required analysis of how the reductions would affect care quality and access.
“There’s a lot of pain going on everywhere, but it’s clearly a crisis in long-term care,” Weeks said.
“You’re going to find that some folks go out of business,” he said. “Some will look for more Medicare patients — Medicare pays more than Medicaid.”
In Washington, D.C., health care interests are resisting President Barack Obama’s plan to pay for his health care overhaul by slowing Medicaid and Medicare spending. Obama wants to trim $313 billion from the two programs over 10 years.
It’s not clear exactly how all the health spending cuts will affect nursing homes.
A University of Pittsburgh study earlier this year found nearly 1,800 nursing homes nationwide closed from 1999 to 2005, about 2 percent each year.
One of the study’s authors, health policy and management professor Nick Castle, said the annual closure rate is rising, for reasons that include inadequate Medicaid reimbursement rates and the push for more home and community care.
“It’s come to a head recently with state budgets being in such jeopardy that they’re cutting in all areas,” Castle said.
The federal stimulus package approved in February includes $87 billion in Medicaid funding to help states. But Connecticut and several other states are using a loophole in the legislation to divert the money to budget items unrelated to health care, according to a congressional study.
On average, Medicaid payments by states to nursing homes fell short by $12 per patient, per day last year — nearly $4.2 billion in unreimbursed costs for Medicaid-allowed expenses, according to the AHCA.
In New York City, the Metropolitan Jewish Health System laid off about 200 of its 1,000 employees at three nursing homes in Brooklyn because the state cut Medicaid funding by 10 percent to 14 percent, said President and Chief Executive Eli Feldman.
“We understand there’s a recession/depression,” Feldman said. “But this is not health reform … and the victims are basically the people who live in the facilities. The Legislature basically says, ‘Too sick, too old, too bad.”

In the United States, it has been estimated that as many as one hospital patient in ten acquires a nosocomial infection, or 2 million patients a year. Estimates of the annual cost range from $4.5 billion to $11 billion and up. Nosocomial infections contributed to 88,000 deaths in the U.S. in 1995. One third of nosocomial infections are considered preventable. Ms. magazine reports that as many as 92 percent of deaths from hospital infections could be prevented.[3] The most common nosocomial infections are of the urinary tract, surgical site and various pneumonias [4]
In France, prevalence in a sample of hospital patients was 6.7% in 1990, and the rate of nosocomial infections was 7.4% (patients may have several infections).[5] At national level, prevalence among patients in health care facilities was 6.7% in 1996[6], 5.9% in 2001[7] and 5.0% in 2006.[8]. The rates for nosocomial infections were 7.6% in 1996, 6.4% in 2001 and 5.4% in 2006.
In 2006, the most common infection sites were urinary tract infections (30,3 %), pneumopathy (14,7 %), infections of surgery site (14,2 %). infections of the skin and mucous membrane (10,2 %), other respiratory infections (6,8%) and bacterial infections / blood poisoning (6,4 %).[9]
The rates among adult patients in intensive care were 13,5% in 2004, 14,6% in 2005, 14,1% in 2006 and 14.4% in 2007.[10]
It has been estimated that nosocomial infections make patients stay in the hospital 4-5 additional days. Around 2004-2005, about 9,000 people died each year with a nosocomial infection, of which about 4,200 would have survived without this infection.[11]
In Italy, in the 2000s, about 6.7 % of hospitalized patients were infected, i.e. between 450,000 and 700,000 patients, which caused between 4,500 and 7,000 deaths.[12] A survey in Lombardy gave a rate of 4.9% of patients in 2000.[13]
In Switzerland, extrapolations assume about 70,000 hospitalised patients are affected by nosocomial infections (between 2 and 14% of hospitalized patients).[14] A national survey gave a rate of 7.2% of patients in 2004.[15]
The rate of nosocomial infections was estimated at 8.5% of patients in Finland in 2005[16], and 8.2% in England in 2006.[17]
The methods used differ from country to country (definitions used, type of nosocomial infecttons covered, health units surveyed, inclusion or exclusion of imported infections, etc.), so that international comparisons of nosocomial infection rates should be made with the utmost care.
[edit]Transmission

Microorganisms are transmitted in hospitals by several routes, and the same microorganism may be transmitted by more than one route. There are five main routes of transmission—contact, droplet, airborne, common vehicle, and vectorborne.
Contact transmission, the most important and frequent mode of transmission of nosocomial infections, is divided into two subgroups: direct-contact transmission and indirect-contact transmission.
Direct-contact transmission involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host.
Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients. Additionally, the improper use of saline flush syringes, vials, and bags have been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes.[18]
Droplet transmission occurs when droplets are generated from the source person mainly during coughing, sneezing, and talking, and during the performance of certain procedures such as bronchoscopy. Transmission occurs when droplets containing germs from the infected person are propelled a short distance through the air and deposited on the host’s body.
Airborne transmission occurs by dissemination of either airborne droplet nuclei (small-particle residue {5 µm or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air handling and ventilation are required to prevent airborne transmission. Microorganisms transmitted by airborne transmission include Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses.
Common vehicle transmission applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.
Vector borne transmission occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.
[edit]Predisposition to infection

Factors predisposing a patient to infection can broadly be divided into three areas:
People in hospitals are usually already in a poor state of health, impairing their defense against bacteria – advanced age or premature birth along with immunodeficiency (due to drugs, illness, or irradiation) present a general risk, while other diseases can present specific risks – for instance chronic obstructive pulmonary disease can increase chances of respiratory tract infection.
Invasive devices, for instance intubation tubes, catheters, surgical drains and tracheostomy tubes all bypass the body’s natural lines of defence against pathogens and provide an easy route for infection. Patients already colonised on admission are instantly put at greater risk when they undergo an invasive procedure.
A patient’s treatment itself can leave them vulnerable to infection – immunosuppression and antacid treatment undermine the body’s defences, while antimicrobial therapy (removing competitive flora and only leaving resistant organisms) and recurrent blood transfusions have also been identified as risk factors.
[edit]Prevention

[edit]Isolation
Isolation precautions are designed to prevent transmission of microorganisms by common routes in hospitals. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission.
[edit]Handwashing and gloving
Handwashing frequently is called the single most important measure to reduce the risks of transmitting skin microorganisms from one person to another or from one site to another on the same patient. Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is an important component of infection control and isolation precautions.
Although handwashing may seem like a simple process, it is often performed incorrectly. Healthcare settings must continually remind practitioners and visitors on the proper procedure in washing their hands to comply with responsible handwashing. Simple programs such as Henry the Hand, and the use of handwashing signals can assist healthcare facilities in the prevention of nosocomial infections.
All visitors must follow the same procedures as hospital staff to adequately control the spread of infections. Visitors and healthcare personnel are equally to blame in transmitting infections. Moreover, multi-drug resistant infections can leave the hospital and become part of the community flora if we don’t take steps to stop this transmission.
In addition to handwashing, gloves play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First, gloves are worn to provide a protective barrier and to prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin; the wearing of gloves in specified circumstances to reduce the risk of exposures to bloodborne pathogens is mandated by the OSHA Bloodborne Pathogens final rule. Second, gloves are worn to reduce the likelihood that microorganisms present on the hands of personnel will be transmitted to patients during invasive or other patient-care procedures that involve touching a patient’s mucous membranes and nonintact skin. Third, gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a patient or a fomite can transmit these microorganisms to another patient. In this situation, gloves must be changed between patient contacts and hands should be washed after gloves are removed.
Wearing gloves does not replace the need for handwashing, because gloves may have small, non-apparent defects or may be torn during use, and hands can become contaminated during removal of gloves. Failure to change gloves between patient contacts is an infection control hazard.
[edit]Surface sanitation
Sanitizing surfaces is an often overlooked yet critical component of breaking the cycle of infection in health care environments. Modern sanitizing methods such as NAV-CO2 have been effective against gastroenteritis, MRSA, and influenza. Use of hydrogen peroxide vapor has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective against endospore forming bacteria, such as Clostridium difficile, where alcohol has been shown to be ineffective.[19]
[edit]Aprons
Wearing an apron during patient care reduces the risk of infection.[citation needed] The apron should either be disposable or be used only when caring for a specific patient.
[edit]Mitigation

The most effective technique of controlling nosocomial infection is to strategically implement QA / QC measures to the health care sectors and evidence-based management can be a feasible approach. For those VAP/HAP diseases (ventilator-associated pneumonia, hospital-acquired pneumonia), controlling and monitoring hospital indoor air quality needs to be on agenda in management [20] whereas for nosocomial rotavirus infection, a hand hygiene protocol has to be enforced.[21][22][23]
[edit]Known diseases

Ventilator associated pneumonia
Staphylococcus aureus
Methicillin Resistant Staphylococcus aureus (MRSA)
Pseudomonas aeruginosa
Acinetobacter baumannii
Stenotrophomonas maltophilia
Clostridium difficile
Tuberculosis
Urinary tract infection
Hospital-acquired pneumonia (HAP)
Gastroenteritis
Vancomycin-Resistant Enterococcus
Legionella

In return, I would like your kind help in debugging and helping me improve this.

This can be done on two fronts.

One you use daily if possible. Maybe creating and experimenting in the amount and the kind of mixtures you like.

Two helping get the word out so I can get a hundred more involved in the test rides. I do not mix money with my passion, so I am not looking for your money. That being said I am however refining this so it can be given to all anywhere in the world. That will come when the feeling pulls the right people in. I really appreciate you discovering my website and only ask that you use it. I state that because I sent one out and the son did not use it to help his mother and I felt badly. Thanks Rich

I write fast and straight from the heart so forgive me for errors in grammar. Also I am 61 and do not take a good picture1 ;_)

So send me your shipping details and I will get one in the mail tomorrow. Then start teaching you how it is used. I am so glad you are invovled.

I haven’t had bedsore-related problems recently as we’re careful with everything and I lost 25kg over three years (been stable for a year now) which helped hugely with that. And switching to the sorbolene helped too as my skin’s less likely to crack and infected spots develop bedsores much more easily. I also have a pressure-reducing mattress – until recently it was an alternating air overlay but I’ve managed to successfully switch to a mattress with a roho cushion insert (like used in wheelchair cushions) which goes about from my shoulders to my knees and is about the width of my hips. It’s fantastic not to need that annoying air pump going on and off all the time .

Cheers,
Ricky

I’ll drop you an email and we can talk more!

Cheers,
Ricky Buchanan

There are some raw Australian honeys which make fantastic antiseptics/antibiotics/antivirals, I know. You can even get the best one in tubes from the pharmacies down here these days! I think it’s fantastic that proper scientific testing is being done on natural products like that so we have unbiased evidence of how well they work.

Cheers,
Ricky