Michigan Disability Resistance

http://bit.ly/2sfpFc6

One in four Michigan residents, nearly 2.5 million people, receive health care coverage through Medicaid.  More than 40 percent of all births in the state are covered by the federal insurance.

So it’s unsurprising that changing eligibility rules, and requiring recipients to work, would cause controversy. The Republican-led plan has attracted national attention in part because its widespread effects, and potential to unspool a key component of the Affordable Care Act.

Proponents say the requirement would encourage more recipients to work, boost a tight labor market and save taxpayers money by moving people off the Medicaid rolls.

The reforms are still a work in progress. Bills originally required recipients to work 29 hours per week, but the requirement could drop to 20 hours per week. Likewise, a controversial exemption to counties with high unemployment rates reportedly will be dropped.

Today, Bridge Magazine looks at key arguments framing the debate, exploring three key questions through a series of maps and charts: Who would be affected? Would it save money? And would it help people get jobs?

The answers, perhaps unsurprisingly, are murky.

Big program, many recipients

Medicaid provides health care coverage for nearly 2.5 million people in Michigan. Of those, 700,000 were added with the expansion allowed by the Affordable Care Act (commonly referred to as Obamacare). Recipients typically must meet income qualifications. They range from the elderly and disabled to children in poverty and adults. Individuals with incomes of $16,000 and families of four making $33,400 are eligible.

Michigan annually spends $16 billion on Medicaid care. Most of the money comes from the federal government, with $4 billion coming from state sources. Half of that,  roughly $2 billion, comes from general taxes.

To help visualize the impact of the changes, Bridge is illustrating the Medicaid population with blocks.

http://bit.ly/2GO053b

Cyril Raben, MD, left a trail of dead or harmed patients across the Midwest.

Jerry Evans died in 2012 in Ohio after spinal surgery by Raben. Donna Marie Oeltjenburnslost more than 2.5 quarts of blood and bled to death when an artery was accidentally cut during surgery in Minnesota in 2009. Terry Paulino was paralyzed from the chest down after spine surgery in Arkansas in 2007.

In all three cases, the physician and his insurance company reached settlements that paid out undisclosed amounts. Yet despite his troubled record, Raben received more than $1.3 million from Medicare from 2013 to 2015, the most recent year available, a MedPage Today/Milwaukee Journal Sentinel investigation found.

Most of that -- $874,000 -- came in 2015, the year after he surrendered his medical license in Ohio.

Raben died last year, but was seeing patients right up to his death.

He is one of at least 216 doctors who remained on Medicare payment rolls in 2015 despite surrendering a license, having one revoked, or being excluded from state-paid health care rolls in the previous five years. In all, those doctors were paid $25.8 million in 2015 alone.

"It makes no sense to continue enabling any doctor who is doing harm to patients," said Richard Deyo, MD, MPH, a professor of evidence-based medicine at Oregon Health and Science University in Portland.

http://bit.ly/2kqcFNy

It isn’t easy for me to write about institutionalization because I’ve been through it. Though it’s been a number of years since I’ve experienced a locked facility, I still feel anxiety when I think of them. Even when visiting hospitals and nursing homes, I get anxious, as if someone will come up behind me and lock the door and I won’t be let out. But it’s this experience that has drawn me to try and explore my aunt’s history of institutionalization, though she had a developmental disability, not a mental health diagnosis, and our stories are very different.

When my aunt Cindy was born with Down syndrome in 1947, institutionalization in a facility like the Montana Developmental Center(MDC) in Boulder was almost certain. Many times, attending “doctors and fathers conspired” and told the mother the infant had died, rather than tell her the child had been born with Down syndrome. Given this context, my aunt Cindy was lucky. Her parents didn’t know she had Down syndrome until she was a toddler. The doctor who delivered her didn’t recognize the traits when she was born, and it wasn’t until she began missing developmental milestones that she was diagnosed. Even then, she wasn’t institutionalized. They kept her at home. If the doctor had recognized that Cindy had Down syndrome at birth, she could have ended up in an institution when she was a baby.

The Montana Developmental Center has been known by many names since it first opened at the end of the 19th century. Originally, it was the Montana School for Backward Feeble-Minded Children. It’s also been called the Montana State Training School, the Boulder River School, and in 1985 it was rebranded as the Montana Developmental Center. It’s listed on the National Parks Service website as a historic site, and is noted for its architecture, spanning Italian Renaissance Revival to Modernist. Its campus is situated in the Elkhorn Mountains. It is picturesque. It is isolated. And at its peak, it warehoused over 1000 people in a facility originally built for a few hundred. Although smaller in scale, MDC was like Willowbrook in the dehumanization of its residents and similarly notorious for its deplorable conditions, neglect, abuse — even rape — of residents, and overworked, underpaid, untrained staff. Per person, it’s the most expensive facility in the state, it’s mostly empty, and has been slated for permanent closure. At some time in the 1960s, my aunt Cindy was institutionalized there.

Although she excelled at making potholders, Cindy wanted to be a waitress at the Park Cafe in Anaconda when she turned twenty-one. But her twenty-first birthday came and went and she never did land that job. It wasn’t possible. There were no community-based services for people with disabilities. There were no job coaches to help people learn the skills they needed for employment. At the time, almost no one believed a person with Down syndrome could lead a “normal” life. Now, we know that’s not true. People with Down syndrome have jobs, own businesses and graduate from high school and college. When I asked my dad about her, he said he didn’t know much, but that as Cindy aged and nothing ever changed, she gradually lost her smile, as if a realization had dawned on her that she would never live the life she wanted. She became quiet. Depressed. That’s how I knew her.

http://bit.ly/2savWWm

Brain pathology can develop from head blows that cause no obvious symptoms.

Concussions per se do not cause chronic traumatic encephalopathy (CTE), a prominent brain researcher said here.

Rather, the condition stems from the accumulation of subacute blows to the head, none of which necessarily has to be severe enough to be diagnosed as a concussion.

So said Lee Goldstein, MD, PhD, of Boston University's CTE Center and School of Medicine, speaking at the eighth annual Traumatic Brain Injury Conference on Thursday. He reviewed some of the center's latest research, including a mouse study published in February in Brain showing that "closed-head impact injuries, independent of concussive signs, can induce traumatic brain injury as well as early pathologies and functional sequelae associated with chronic traumatic encephalopathy."

"We can completely dissociate concussion" from CTE, Goldstein said. Along with a few case studies of human brains, the studies have revealed about CTE "no correlation on the concussion score with anything we have measured," he said.

Goldstein said his group thinks they have seen profiles of dementia in the brains of deceased former contact-sport athletes in their 20s and 30s. This "has nothing to do with concussions," he said, but instead is directly related to hits to the head. The bottom line: Athletes never diagnosed with concussion may still suffer serious brain injury.

The team has also seen early signs of CTE in the brains of teenagers, Goldstein said, citing a 17-year-old male in particular whose brain revealed signs of chronic neurotrauma.

CTE has been a controversial topic in brain injury and sports medicine. While researchers such as Goldstein and colleague Robert Cantu, MD, have argued CTE's connection with contact sports, others have questioned the condition's very existence. Athletic organizations in particular have been slow to accept CTE as a legitimate concern.

http://bit.ly/2s47Qwz

How Nursing Homes in the United States Overmedicate People with Dementia.

Too many times I’m given too many pills…. [Until they wear off], I can’t even talk. I have a thick tongue when they do that. I ask them not to [give me the antipsychotic drugs]. When I say that, they threaten to remove me from the [nursing] home. They get me so I can’t think. I don’t want anything to make me change the person I am.
—Walter L., an 81-year-old man given antipsychotic drugs in a Texas nursing facility, December 2016.

It used to be like a death prison here. We cut our antipsychotics in half in six months. Half our residents were on antipsychotics. Only 10 percent of our residents have a mental illness.
—A director of nursing at a facility in Kansas that succeeded in reducing its rate of antipsychotic drug use, January 2017.

In an average week, nursing facilities in the United States administer antipsychotic drugs to over 179,000 people who do not have diagnoses for which the drugs are approved. The drugs are often given without free and informed consent, which requires a decision based on a discussion of the purpose, risks, benefits, and alternatives to the medical intervention as well as the absence of pressure or coercion in making the decision. Most of these individuals—like most people in nursing homes—have Alzheimer’s disease or another form of dementia. According to US Government Accountability Office (GAO) analysis, facilities often use the drugs to control common symptoms of the disease.

While these symptoms can be distressing for the people who experience them, their families, and nursing facility staff, evidence from clinical trials of the benefits of treating these symptoms with antipsychotic drugs is weak. The US Food and Drug Administration (FDA) never approved them for this use and has warned against its use for these symptoms. Studies find that on average, antipsychotic drugs almost double the risk of death in older people with dementia. When the drugs are administered without informed consent, people are not making the choice to take such a risk.

The drugs’ sedative effect, rather than any anticipated medical benefit, too often drives the high prevalence of use in people with dementia. Antipsychotic drugs alter consciousness and can adversely affect an individual’s ability to interact with others. They can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there. In many facilities, inadequate staff numbers and training make it nearly impossible to take an individualized, comprehensive approach to care. Many nursing facilities have staffing levels well below what experts consider the minimum needed to provide appropriate care.