Only 37% of Long-term Care Facilities Staff Vaccinated for COVID-19

While residents of nursing homes and their caregivers have been considered a top priority for COVID-19 vaccination, only 38% of nursing home staff accepted shots when they were offered.  This according a survey conducted by the Centers for Disease Control and Prevention (CDC). 

Anecdotal reports have been circulating for weeks that nursing home staff members were turning down vaccination offers, but these are the first national-level figures.  Of course, historically, nursing homes trail other health care institutions in the staff penetration of vaccines (see CDC Reports That SNF Workers Most Likely Among Health Care Workers to Forego Recommended Vaccinations). 

Dr. Radhika Gharpure, lead author of the study and a member of the CDC’s Vaccine Task Force wrote, "These findings show we have a lot of work to do to increase confidence and also really understand the barriers to vaccination amongst this population." The report cited previous polling data to suggest why employees have been declining vaccines. Many raised concerns about vaccine side effects. Others said they didn't want to be among the first to receive the vaccines, which were first authorized in December. Some said they didn't trust the government, or referenced false claims about the shots.

Residents, meanwhile, have been much more accepting of vaccines, with 78% receiving at least one shot, according to the new report, which examined vaccination rates at more than 11,000 long-term care facilities nationwide between Dec. 18 and Jan. 17.

Source, "Roughly one-third of long-term care staff vaccinated through federal program: CDC," The Hill (2/1/21).

Nursing Home Chain $5.2 Million Bonus to CEO Amid Pandemic Draws Ire

Photo 59252501 © Lightboxx | Dreamstime.com

A nursing home chain gave its former CEO a $5.2 million “retention payment” at the height of the pandemic drawing a sharp rebuke from Sen. Elizabeth Warren (D-Mass.), who sits on the Senate’s Special Committee on Aging.  Genesis operates more than 300 nursing homes across the country. More than 2,800 of its residents have died of covid-19, and despite receiving more than $300 million in state and federal emergency aid, the company said its finances are so bad that it may not be able to continue as a going concern. 

"Sen. Warren calls Genesis Healthcare executive bonus act of ‘unfathomable greed’" reads the headline to the article published in the Washington Post.  According to the article, Warren characterized the compensation as "inexplicable and unseemly” in a letter dated Jan. 27. She asked the company board to explain its decision and to provide the minutes of all meetings in 2020 where compensation was discussed. Warren also warned the company not to seek additional emergency relief from Washington.

Senator Warren's letter is available here. 

Hands-free Shoes Courtesy of Nike- The Aging in Place Connection

Go Flyease by Nike
image used under fair use

Nike has announced innovative hands-free shoes called Go Flyease. The CNN article,  "Nike Made a Hands-free Shoe and You Have to See it to Believe it," describes the new shoe:

"[I]t's Nike's first pair of lace-less sneakers that can easily be put on and taken off without using your hands. The casual shoe arrives at a time when people are touching fewer things during the pandemic and a revival of comfier counterparts that take minimal effort to take on and off...."  

The description and the video demo suggest that  donning the shoes is easy and comfortable.  These are not just traditional slip-ons, like slippers, moccasins, or crocs, which often require hands to either put on or adjust, and often fit quite loosely.  The shoe actually snaps in place around the foot when stepping into the shoe.  The article explains that:

"[t]he Go Flyease has unique features, including a tension band that secures the shoe in place of laces. Putting them on involves just stepping into the shoe so that it will snap into place. Taking them off is done by stepping on the heel." 

Aside from pandemic justification, the shoes make aging in place easier, permitting anyone to don or shed shoes without the assistance of another, and without the danger that often accompanies too loose fitting shoes, especially for folks with impaired sensitivity in their extremities. Reduced flexibility, injury, joint pain; all of these conditions sometimes make putting on and tying shoes difficult.  No longer will seniors have to accept the trade-off of a trip hazard for comfort, convenience and ease.  Congratulations Nike!  

The shoe is not yet available for order, but when it is available, you can order a pair here.  

Long-term Care Industry Forecast to Lose $94 Billion Amid Pandemic

The long-term care industry will lose $94 billion over a two-year period as a result of COVID-related costs and revenue losses, according to a new forecast from the nation’s largest nursing home association. 

The American Health Care Association/National Center for Assisted Living detailed its projections Tuesday. Its analysis found that providers spent an estimated $30 billion in 2020 on COVID-related costs, such as hiring more staff members and purchasing personal protective equipment. That number is projected to be $30 billion again for 2021.

In terms of revenue, nursing home operators have lost $11.3 billion in 2021. Provider losses are projected to rise to $22.6 billion in 2021, according to AHCA/NCAL.  

The combination of revenue declines and increased costs resulted in 143 facility closures and mergers in 2020, the report stated. That’s projected to reach 1,670 closures/mergers in 2021 if business conditions do not change. 

AHCA/NCAL is an industry advocate, of course, but it claims the findings justify the need for additional and immediate support for long-term care. The association called for allocating $20 billion to the long-term care industry through enhanced Federal Medicaid Assistance Percentage (FMAP) for long-term services and support, or through a dedicated portion to the Provider Relief Fund, top priority for vaccine distribution and access to testing and supplies. 

“Congress and the Biden Administration must prioritize the long-term care industry and ensure the dedicated front-line workers of these facilities have the necessary resources to protect their residents and themselves,” AHCA/NCAL warned.

Of course, consumers, in the end have the most to lose.  Concerns regarding quality care, security, and staffing, for example, are only heightened when the industry is not profitable.  

Source:  D. Brown, "Long-term care to lose $94 billion due to pandemic: forecast," McKnight's Long-term Care News.

Nursing Home Critics Say COVID-19 Immunity Laws Are A Free Pass For Neglect

 As nursing home residents contend with both the effects of the COVID-19 pandemic, and the already dangerous nature of institutional care care resulting from abuse, neglect, and mistakes, critics and advocates are focusing attention on liability protections afforded these institutions.

As previously discussed, these protections are already being challenged in court cases.  For those who plan to age in place, the discussion presents just another in a litany of reasons to avoid institutional care.  With more than one-third of nursing home residents being injured or killed by mistakes in institutions before COVID-19, the case for aging in place planning could not be more clear. 

The following is a reprint of the NPR article entitled, Nursing Home Critics Say COVID-19 Immunity Laws Are A Free Pass For Neglect:

Palestine Howze died April 14, 2020, in a North Carolina nursing home.

She had developed a pressure ulcer — or bed sore as they're commonly known. It flared up in December 2018 and just grew worse, says her daughter Lisa Howze. Infection set in.

"We begged them to take her to the emergency room, but they assured us that they could handle it," Howze says.

Howze and her three sisters contend that the nursing home could not. In their experience, Treyburn Rehabilitation Center in Durham didn't seem to be able to handle much. On a scale of one to five stars, the federal government gives Treyburn just one. It also gets below-average ratings on the ratio of nurses to residents. The government has fined Treyburn almost $190,000 in the past three years.

Lisa Howze and her sisters have filed a lawsuit against Treyburn Rehabilitation Center. But it's unclear whether it can proceed.

Like nearly 30 other states, North Carolina granted legal immunity to nursing homes to shield them from COVID-19 lawsuits. Nursing homes argued that they needed protection as the coronavirus raged through their facilities and the recommended safety guidance from the Centers for Disease Control and Prevention fluctuated.

But that immunity raises questions for families like the Howzes, who contend that because their mother's death had nothing to do with the coronavirus, they should be able to legally hold Treyburn Rehabilitation Center accountable.

"Palestine Howze did not have to die in that way or at that time," says Elizabeth Todd, the family's attorney. Their lawsuit is believed to be the first of its kind to challenge nursing home immunity.

The Howze sisters hadn't had a lot of luck with nursing homes in general. Treyburn was the third one they'd tried. But it was close to where they lived, so the sisters could visit often to keep an eye on things. They needed to, says Lisa Howze.

"We were there a lot and we found ourselves having to bathe her, just general things they were supposed to do," Howze says. "We'd come in several times when she hadn't been fed her tray; [it was] just sitting there."

Then COVID-19 exploded across the country, taking an especially deadly toll in nursing homes — which have accounted for more than a third of all coronavirus-related deaths. Nursing homes closed their doors in March, locking families out as the industry tried to control the outbreaks. Everything got harder. And took longer.

Palestine Howze needed specialists in wound care and IV antibiotics. Lisa Howze had her mother's power of attorney. Again, she says she begged Treyburn Rehabilitation Center to send her mother to a hospital emergency room where they could find the specialists she needed. Again, she was turned down.

"Their excuses were, 'Well, you know, the emergency room at the hospital is not taking new patients because of COVID. And she would be safer here if she stayed here. And the facility is equipped to take care of your mother.'"

None of those things turned out to be true, Lisa Howze says.

In May, a month after Palestine Howze died, North Carolina passed a sweeping liability shield for long-term-care facilities, meaning that nursing homes — with rare exceptions — were immune from lawsuits. The measure was made retroactive to March 10, a few weeks before her mother's death.

Lisa Howze and her sisters decided to sue Treyburn anyway.

"For the legislature to say that the nursing homes need protection in the middle of a pandemic, not the nursing home patients, is outrageous and it's unjust," says Todd, their attorney.

North Carolina's immunity law lasts until the pandemic is over. Todd is especially worried that the law gives a free pass to nursing homes with low staffing, like Treyburn.

"Literally, the nursing homes can take their own understaffing, their chronic understaffing, and use it as a shield to prevent any liability at all during the COVID pandemic," Todd says.

Through its attorneys, Treyburn Rehabilitation Center declined to comment.

But for many in the long-term-care industry, these immunity measures are a welcome relief, says Dave Voepel, CEO of the Arizona Health Care Association. Arizona Gov. Doug Ducey was among the first to sign an executive order granting nursing and assisted living facilities legal immunity.

ong-term-care facilities are facing a crisis of existential proportions, says Mark Reagan, the attorney for the California Association of Health Facilities.

That's because liability insurers are excluding all things COVID-19 when they renew policies.

That "would mean that any claims made regarding COVID infection, regardless of when that infection occurred in the past, would be subject to exclusion and no insurance coverage," says Reagan.

California does not have a liability shield, but the state has waivers, relaxing standards for personnel and bed space, for example. Congressional Republicans wanted a national immunity law but dropped it as part of the deal for the latest coronavirus relief package. Reagan still has hopes.

"What we are merely asking for is that caregivers and their employers don't get punished for doing the best that they could under the circumstances," he says.

But attorney Elizabeth Todd says Treyburn Rehabilitation Center wasn't doing the best it could for Palestine Howze. And she says that one of North Carolina's immunity criteria is that a facility must be acting in good faith, though that's not defined in the law.

"And so we argue the pretty shoddy state of Treyburn nursing home as COVID approached, and then as Mrs. Howze became very ill, that that was not providing health care in good faith," she says.

A Superior Court judge will decide whether to dismiss the case because of the immunity statute or allow it to continue, potentially giving Lisa Howze and her sisters their day in court.

"And for that we applaud him, because that just takes a little bit of pressure off," Voepel says, adding that it allows facilities to focus on what's most important. "We need to worry about keeping COVID out of the building."

Sometimes, he says, that cuts into the bottom line.

"Take, for instance, a 100-bed building and they really have 50 rooms, two beds per room," Voepel says. But to keep infection from spreading, those rooms may have to be converted to private rooms. So revenue is cut in half.

"It really takes its toll on the business side of the ledger," says Voepel.

Long-term-care facilities are facing a crisis of existential proportions, says Mark Reagan, the attorney for the California Association of Health Facilities.

That's because liability insurers are excluding all things COVID-19 when they renew policies.

That "would mean that any claims made regarding COVID infection, regardless of when that infection occurred in the past, would be subject to exclusion and no insurance coverage," says Reagan.

California does not have a liability shield, but the state has waivers, relaxing standards for personnel and bed space, for example. Congressional Republicans wanted a national immunity law but dropped it as part of the deal for the latest coronavirus relief package. Reagan still has hopes.

"What we are merely asking for is that caregivers and their employers don't get punished for doing the best that they could under the circumstances," he says.

But attorney Elizabeth Todd says Treyburn Rehabilitation Center wasn't doing the best it could for Palestine Howze. And she says that one of North Carolina's immunity criteria is that a facility must be acting in good faith, though that's not defined in the law.

"And so we argue the pretty shoddy state of Treyburn nursing home as COVID approached, and then as Mrs. Howze became very ill, that that was not providing health care in good faith," she says.

A Superior Court judge will decide whether to dismiss the case because of the immunity statute or allow it to continue, potentially giving Lisa Howze and her sisters their day in court.

New York Undercounted Nursing Home Death Toll by 56%; Scrutiny Turns to Other States

New York’s nursing-home death toll from COVID-19 may be more than 50 percent higher than officials claim, because Gov. Andrew Cuomo’s administration hasn’t revealed how many of those residents died in hospitals.  This according to state Attorney General Letitia James. 

James issued a damning, 76-page report, stating that some unidentified nursing homes apparently underreported resident fatalities to the state Department of Health and failed to enforce infection-control measures — with more than 20 currently under investigation.

The bombshell findings could push the current DOH tally of 8,711 deaths to more than 13,000, based on a survey of 62 nursing homes that found the state undercounted the fatalities there by an average of 56 percent.

The report further notes that at least 4,000 residents died after the state issued a controversial Cuomo administration mandate for nursing homes to admit “medically stable” coronavirus patients — which James said “may have put residents at increased risk of harm in some facilities.”

While the news from New York is horrific, New York is not alone in either poor policy that arguably caused increased nursing home COVID-19 death, or in efforts to conceal the numbers.  Daniel Greenfield, reporter for FrontPageMag began reporting on the story in April, 2020, in a story entitled, "1 in 5 Coronavirus Deaths Could Have Been Prevented by Securing Nursing Homes."  

Greenfield's article is partisan, and at times his rhetoric is incendiary, but it is quoted accurately lest one claim that the rhetoric was removed to make it seem less partisan; the reader can discern whether partisanship in whole or part colors the reportage towards inaccuracy.  He wrote:

"Over 7,000 of the country’s coronavirus deaths emerged out of nursing homes.

Of the 4,377 coronavirus deaths in New Jersey, over 1,700 died due to infections in nursing homes. That nearly 40% of coronavirus deaths in one of the hardest hit states took place in nursing homes casts a stark light on the misplaced priorities of blue states battling the pandemic by locking down houses of worship and small businesses, while putting few to no resources into protecting nursing home residents.

New Jersey’s coronavirus deaths were part of the coronavirus outbreak in 425 nursing homes. At one nursing home, after an anonymous tip, police found 17 bodies being stored in a shed.

Nearly 7,000 nursing home residents in the state have tested positive for coronavirus.

In neighboring New York, nearly 1 in 4 coronavirus deaths emerged from nursing homes. Those 3,060 deaths are only part of the story and represent an extremely incomplete picture. The Health Department had battled against releasing the information, claiming that it was protecting the privacy of residents. Even when the people pleading for the release of the information were their own loved ones.

In one facility, 17% of the residents have died. In 5 others, more than 10% are dead.

And even now, only data from a fraction of nursing homes in the state has been made public.

Why were New York authorities so reluctant to release the information? Even the partial data makes it all too clear that the severity of the death toll was not due to urban density, but poor oversight and response. If urban density were the issue, Manhattan would have some of the highest numbers. Instead it has among the lowest, while boroughs with sizable nursing homes have the highest numbers.

The actual nursing home death toll in New York may be closer to 3,316.

In New York City, while the official numbers peg it at 688, the actual numbers may be over 2,000.

And the death toll, actual or estimated, is only a part of a bigger picture with 8% of nursing home residents in the state testing positive for the virus. Those numbers make it painfully clear that the dying is likely to continue and that authorities have utterly failed to secure our most vulnerable population.

The Cuomo administration is blaming nursing homes. And while nursing homes often provide poor care and personnel often work in different facilities at the same time spreading the infection between them, it was the state that ordered facilities to accept coronavirus patients returning from the hospital.

Governor Cuomo's Department of Health had issued an order that, "no resident shall be denied re-admission or admission to the NH solely based on a confirmed or suspected diagnosis of COVID-19" and also prohibited requiring testing of returning patients. Sending hospitalized patients with coronavirus to the same mismanaged nursing homes was a death sentence for countless seniors in those facilities.

As Betsy McCaughey, the former Republican lieutenant governor, has said, "One Covid-positive patient in a nursing home produces carnage.”

.     .     . 

In Connecticut, 40% of coronavirus fatalities emerged from nursing homes.

In Virginia, the majority of the coronavirus outbreaks have taken place in nursing homes. Like New York, Virginia’s Department of Health is refusing to release the names of the facilities with outbreaks.

That means loved ones have no way to know if their families are at risk.

Governor Ralph Northam's administration is continuing to engage in the cover-up even as a quarter of the population in one facility died of the coronavirus. That outbreak was the deadliest in America.

In Illinois, Governor Pritzker's administration had fought against providing the numbers of deaths and the identity of the nursing homes with outbreaks by claiming that it was protecting the privacy of residents, but finally began putting out some numbers about coronavirus deaths in nursing homes.

1 in 4 coronavirus deaths in Cook County, an area which includes Chicago, took place in nursing homes.

In Michigan, Governor Gretchen Whitmer's administration also refused to release the names of infected facilities. What information reporters have put together indicates that over a third of coronavirus deaths in Wayne County took place in nursing homes. Every nursing home in Detroit is infected.

“We have a crisis in our nursing homes,” Mayor Mike Duggan admitted, as 35% of nursing home residents tested had the virus.

In California, 29% of the deaths in Los Angeles County have taken place in nursing homes. In nearby Long Beach, it’s as high as 72%. In one Central Valley home, 156 residents tested positive and 8 died.

The Newsom administration, like its blue state counterparts, dragged its feet on releasing nursing home information, until its feet were held to the fire.

Governor Newsom is now claiming that nursing home residents are his top priority. “This state has a disproportionate number of aging and graying individuals, and we have a unique responsibility to take care of them and their caregivers.”

Except that California, like New York, was forcing care facilities to accept coronavirus patients discharged from hospitals. Newsom, like Cuomo, has blood on his manicured hands.

The ten deadliest outbreaks in this country have taken place in nursing homes and care facilities.

While officials around the country shut down churches and synagogues, arrested people for surfing and playing catch, and sent drones flying over their backyards, little was done to secure the estimated 4,100 nursing homes out of over 15,000 in the country where coronavirus was known to have taken root.

Even though the first coronavirus outbreak in this country took place in a nursing home in Washington, and killed 43 people, the CDC failed to track the spread of the virus to nursing homes nationwide.

Instead, the CDC has been relying on "informal outreach" to track the spread and has not updated its numbers since March.

The CDC's estimate of 400 nursing homes is only about 10% of the national total.

The Trump administration took an important step by ordering nursing homes to report coronavirus deaths to the CDC, and to the residents and their families. This move puts an end to the state stonewalling that covered up coronavirus cases and their own malfeasance.

It’s the beginning. Not the end."

Last May, Greenfield revisited the scandal.  He wrote:

"While New York had banned testing as a basis for nursing home admission, in Florida, a “COVID-19 test must be negative prior to transfer to a post-acute facility.

Governor DeSantis noted that his ban on sending coronavirus patients to nursing homes is the reason why the nursing home death toll was 13 times higher in New York and 25 times higher in New Jersey.

The media falsely claims that after at least 12,000 dead grandmas and grandpas, Cuomo, Whitmer, Murphy, and Newsom did a wonderful job, and DeSantis did a terrible one. Their measure of success isn’t in grandmas saved, but in small businesses shut down, people terrified, and government power made absolute."

And if the media gets to write the history of the pandemic, that is what our children will be taught."    

Greenfield wrote recently, in light of James' report:

"This is a story I broke back in the spring. It's steadily gotten worse since then as Cuomo's decision to force nursing homes to accept infected coronavirus patients helped lead to a massive death toll.

New York isn't unique in that regard. A number of Democrat states, including New Jersey and Pennsylvania, whose health secretary, Rick Levine, was picked by Biden as his assistant health secretary, did the same or similar things. But the death toll has been huge in New York and so has the cover-up.

Cuomo has refused to release the true numbers of fatalities. Now AG Letitia James, who seems to specialize in only political investigations, has a preliminary report about the real death toll.

That's an obvious shot at Cuomo and an indication she plans to run against him.

James and her office have very little credibility, but the report is worth looking at nonetheless."  

After reciting James' findings, he noted, "[a] more extensive report would line up facilities that had admitted infected patients with those with high death tolls and combine death tolls from facilities and hospitals."  More, a comprehensive assessment would consider tracing and identify how many cases owe as their source an infected institutional care resident or worker, or a family member of either.    

There are several takeaways from the whole sordid affair, regardless of the underlying debates regarding COVID-19, generally:

• First, health care has become a partisan issue, and the health and well-being of individuals is only one, and not always the primary, objective of partisans.
• Second, where partisanship exists, information must be read and evaluated critically; figures lie, and liars figure.
• Third, in a battle between the individual versus the institution, any single individual is largely powerless against any large institution, especially where that individual is vulnerable, and this is even more profoundly obvious over a short time frame.  Although an individual with the right ideas, like Martin Luther King, can effectuate change over time, the individual will rarely see immediate success, and as a result may suffer greatly in pursuing change.  
• Fourth, in planning for one's self and loved ones, one should, as much as possible, eschew broad institutional solutions, including those of the legal, health, and  financial systems.  Generally, these are supposed to, and in most cases, actually do protect the individual, but when they fail, they fail spectacularly. 
• Fifth, plan to age in place, and, therefore, implement a legal, health, financial, and social plan to communicate, implement, and empower that objective.    

Original Source: New York Post

Lawsuit Challenges Nursing Home Liability Protections for Non-COVID Death

Survivors of a former North Carolina nursing home resident are suing the facility where she died in what McKnight's Long-term Care News reports "could be a litmus test for the patchwork of liability protections granted to healthcare providers across the country."

North Carolina is one of nearly 30 states that extended nursing homes legal immunity to shield them from lawsuits during the pandemic. Nursing homes claimed that they need protection since they became ground zero for the contagion.  The industry  lobbied unsuccessfully for national liability protections. 

The family of Palestine Howze is pursuing a case against Treyburn Rehabilitation Center in Durham, NC, where she died in April of non-COVID causes. In many cases, immunity given during the pandemic extends beyond COVID-related cases.
The family’s lawsuit is believed to be the first of its kind to challenge nursing home immunity.” The family claims that Howze developed a pressure ulcer that became infected, and the facility declined to send her to the hospital for treatment citing the pandemic.

North Carolina passed its liability shield law a month after Howze’s death and made it retroactive to March 10, 2020. It runs through the end of the public health emergency, which is currently extended into April but is projected to be lengthened at least through 2021.

“For the Legislature to say that the nursing homes need protection in the middle of a pandemic, not the nursing home patients, is outrageous and it’s unjust,” Elizabeth Todd, the family’s attorney, told NPR.

In October, a federal court ruled that a Pennsylvania nursing home could not claim preemption and federal immunity under the “Public Readiness and Emergency Preparedness Act,” or PREP Act. Although then-Sen. Majority Leader Mitch McConnell (R-KY) argued for federal corporate liability protections, he abandoned the fight in agreeing to a second COVID-19 relief package in December.
ProPublica and The News & Observer first reported on the Howze family’s suit.  A lawyer for Treyburn’s owner, Sovereign Healthcare Holdings, reportedly stated that “the case is defensible, factually and legally, and we would prefer to let the legal process run its course on both fronts.”

Many have expressed concern that protecting institutions from liability will only discourage institutions from behaviors and policies most likely to protect residents.  This is troubling given that more than 40% of COVID-19 death nationwide are attributed to long term institutional care facilities like nursing homes and assisted living facilities. New reports suggest the numbers of institutional care COVID-related deaths is frighteningly under reported. Legal experts have opined that facilities may still be held liable for gross negligence under the orders.  

The Howze case could prove the accuracy of the latter opinion. A North Carolina Superior Court judge must now decide whether to dismiss it because of the immunity statute or allow it to continue, possibly in arbitration. That could take months in a state where courts are already backed up due to the pandemic.

IRS Contests Value of Prince Estate, Who Died Without A Will Claiming Estate Worth $163.2 Million

The ongoing controversy over the money left behind by Prince when he died without a will is heating up again after Internal Revenue Service calculations showed that executors of the rock star's estate undervalued it by 50 percent, or about $80 million.

The IRS determined that Prince’s estate is worth $163.2 million, overshadowing the $82.3 million valuation submitted by Comerica Bank & Trust, the estate’s administrator. The discrepancy primarily involves Prince’s music publishing and recording interests, according to court documents.

Documents show the IRS believes that Prince's estate owes another $32.4 million in federal taxes, roughly doubling the tax bill based on Comerica’s valuation, the Star Tribune reported.

The IRS also has ordered a $6.4 million “accuracy-related penalty” on Prince’s estate, citing a “substantial” undervaluation of assets, documents show.

Prince’s death of a fentanyl overdose on April 21, 2016, created one of the largest and most complicated probate court proceedings in Minnesota history. Estimates of his net worth have varied widely, from $100 million to $300 million.

With Prince’s probate case dragging on, his six sibling heirs have grown increasingly unhappy, particularly as the estate has doled out tens of millions of dollars to lawyers and consultants.

Comerica and its lawyers at Fredrikson & Byron in Minneapolis maintain their estate valuations are solid. Comerica sued the IRS this summer in U.S. Tax Court in Washington, D.C., saying the agency’s calculations are riddled with errors.

“What we have here is a classic battle of the experts — the estate’s experts and the IRS’ experts,” said Dennis Patrick, an estate planning attorney at DeWitt LLP in Minneapolis who is not involved in the case. Valuing a large estate, Patrick added, “is way more of an art than a science.”

Comerica, a Dallas-based financial services giant, has asked the tax court to hold a trial in St. Paul. A trial could dramatically lengthen the settlement of Prince’s estate and generate more legal fees at the expense of Prince’s heirs, Patrick said.

Source: NBC News  

Picture: Photo 22858528 © Furesz | Dreamstime.com

Florida Investigates Nursing Home Reportedly Funneling Vaccines to Rich Donors

The State of Florida is investigating allegations that an upscale West Palm Beach nursing home diverted scarce COVID-19 vaccinations meant for residents and staff to members of the facility’s board of directors and donors.  

Appearing at a press conference in Vero Beach, Governor Ron DeSantis said that the Florida Department of Health was investigating reports that MorseLife Health System chief executive Keith Myers offered vaccinations to some of the long-term care facility’s board members and wealthy donors.  DeSantis said he also directed Florida Inspector General Melinda Miguel to investigate the allegations in stories published this week.

Emily Smith of Page Six reported that real estate moguls Bill and David S. Mack arranged for their “wealthy friends from Manhattan and the ritzy Palm Beach Country Club to get the COVID-19 vaccine at a Florida retirement home.”  The Washington Post reported that MorseLife made the vaccinations “available not just to its residents but to board members and those who made generous donations to the facility, including members of the Palm Beach Country Club, according to multiple people who were offered access, some of whom accepted it.”  DeSantis assured the public that Florida started the investigation “as soon as we found out about it.”

The governor’s remarks came on the heels of U.S. Sen. Rick Scott’s public call for an investigation into the allegation.  "It is absolutely disgusting and immoral that anyone would take vaccines intended for nursing home residents to distribute them to their friends," Scott, a Republican and former Florida governor, said in a statement. "This type of gross mismanagement will not be tolerated, and those responsible must be held accountable."

The federal government inked agreements last year with CVS and Walgreens to provide COVID-19 vaccinations to staff and residents of nursing homes and assisted-living facilities.  Hospital frontline health-care workers and residents of the long-term care facilities were the initial groups of people who qualified for Pfizer Inc. and Moderna vaccinations.

DeSantis on Dec. 23 announced that he was broadening eligibility to include all health care workers as well as people who are 65 or older.  The move led to chaos, resulting in jammed phone lines, overwhelmed websites and, in some instances, lines of seniors camping out over night to be first in line for vaccines.  In other words, it may be that the nursing home was simply providing the vaccine to its donors and others who it thought may have qualified under the broader DeSantis eligibility.  Regardless, the optics couldn't be worse for the nursing home provider.  

DeSantis emphasized Thursday that the vaccinations at the center of the controversy were not supplied by hospitals or county health departments, but were part of the federal arrangement with retail pharmacies.

“The nursing home and long-term care program is for residents and staff of long-term care facilities. That’s who it's for. Look, if you’re not a resident or a member of a long-term care facility but you’re 65 and up, there’s other options for you. We want you to get vaccinated. But to go under that rubric when you are not a resident and you’re not a staff member, that is definitely going outside of what the guidance is and what the program is for,” the governor said.

Potential Miracle Treatment Promoted by Feds for SNFs

COVID-19 monoclonal antibodies are now widely available for use by skilled nursing facilities  — and early results show promise, according to long-term care pharmacy leaders. Kimberly Marselas, writing for McKnight's Long-term Care News outlined the great news in her article, A potential ‘miracle’? Feds push monoclonal antibody treatments toward SNFs.  The following is an annotated reprint of her excellent article.

The Department of Health and Human Services’ (DHS) Project SPEED, or Special Projects for Equitable and Efficient Distribution, aims to get monoclonal treatment to COVID patients in non-hospital settings with priority populations, including nursing homes and assisted living facilities [some links added]. It goes beyond an earlier pilot spearheaded by CVS Health that targeted nursing homes and patients at home in seven cities with rapidly rising COVID rates.

The program is now open to any licensed pharmacy, said Chad Worz, PharmD, CEO and executive director of the American Society of Consultant Pharmacists, during an online update last week. He said LTC pharmacies around the country are beginning to add the therapeutic drugs, which mimic the body’s natural immune response, to their formularies.

As word spreads about availability, Worz expects increasing demand from skilled nursing providers who see antibodies as a way of mitigating COVID symptoms and preventing hospitalizations.

On the same webinar, T.J. Griffin, R.Ph., senior vice president of long-term care operations and chief pharmacy officer at PharMerica, said he is working closely with two nursing homes in Chicago and San Antonio that have used antibodies on a total of 70 patients since the program’s launch.

“The medical directors of both places have called it a miracle,” Griffin said. “So far, none of these patients have gone back to the hospital.”

Because most clinical data on monoclonal antibodies comes from hospitals, there’s not much evidence about its success in nursing home residents. But Griffin said he is working to gather and report information to HHS, and urged others to document and share patient responses.

Use protected during public health emergency

One pharmacist on the call noted a facility he worked with declined to administer the antibodies, citing liability concerns. But Worz said federal PREP Act protections would apply to skilled facilities that administer them safely and effectively and monitor for anaphylactic shock.

Arnold Clayman, ASCP’s vice president of pharmacy practice and government affairs, said infusion could be handled by staff members with an infusion license where required. Non-skilled facilities, or those without nurses to spare, could also tap into a separate program being led by the National Home Infusion Association in 46 states and Washington, D.C.

To date, only bamlanivimab, widely known as BAM, has been made available to LTC pharmacies. But Worz is also advocating for doses of Regeneron’s version, which requires pharmacists to compound casirivimab and imdevimab.

Both types of monoclonal antibodies received Emergency Use Authorization in mid-November with initial shipments sent to hospitals. But many said they were simply too busy treating severe COVID cases to deliver the outpatient therapy. As of late December, just 20% of the available antibodies had been used.

“That’s the reason they’re pushing it to long-term care, because (HHS) saw stockpiling in hospitals,” Worz said.

Wider use covered by CMS

Pharmacies can order for weekly delivery, or arrange for an emergency shipment in the case of a known outbreak, but Worz said HHS is tracking inventory to ensure the potentially life-saving product doesn’t continue to sit unused.

Medicare and Medicaid coverage of the use of monoclonal antibody therapy for COVID-19 treatments extends to beneficiaries in nursing homes at no cost during the public health emergency.

AMDA — The Society for Post-Acute and Long-Term Care Medicine, which initially expressed skepticism about the efficacy of antibody treatments in nursing homes because of a lack of data, has now partnered with ASCP to assist with Project Speed.

John Redd, M.D., MPH, chief medical officer, Office of the Assistant Secretary for Preparedness and Response at HHS, previously told McKnight’s that medical directors and physicians who care for long-term care patients are “crucial” to expanded delivery of the antibody treatment.

“We intend to engage them with every phase of the rollout,” he said.  “This therapeutic is intended to treat patients with COVID-19 risk factors who are early in their disease, which includes the majority of residents of long-term care facilities.”