Hospital finances bleak as 2020 nears end

Hospital margins and revenues continued to fall in November, while expenses remained above 2019 levels, according to Kaufman Hall’s December Flash report, which examines metrics from the previous month. 

The median hospital operating margin in November was 2.5 percent year to date with funding from the Coronavirus Aid, Relief and Economic Security Act. Without the funds, the median hospital operating margin narrowed to -1.1 percent. 

Skyrocketing COVID-19 cases are already stretching hospitals’ capacity, and Kaufman Hall expects the situation to worsen in coming months as holiday gatherings and colder weather push case counts up even further. 

An investment firm snapped up nursing homes during the pandemic

https://www.washingtonpost.com/local/portopiccolo-nursing-homes-maryland/2020/12/21/a1ffb2a6-292b-11eb-9b14-ad872157ebc9_story.html?fbclid=IwAR2O7OAWs8sCQMk6bk7jiwW2oTeguaqiBnjLxLf8rYOhD05oaAnGnqYf_Oc

Private Equity Fundraising Set Record in 2019: PitchBook | ThinkAdvisor

An investment firm has bought more than 20 nursing homes during the coronavirus pandemic, leading to disruptions at multiple facilities that weakened care for vulnerable residents amid the worst health crisis in generations, interviews and documents show.

From April through July, the New Jersey-based Portopiccolo Group — which buys troubled nursing homes and tries to make them profitable — paid hundreds of millions of dollars to acquire facilities in Maryland, Virginia and elsewhere.

The purchases drew scant scrutiny from regulators despite poor safety records at dozens of the company’s other nursing homes, including hefty fines for infection-control lapses and shortages of staff.

Many of Portopiccolo’s existing facilities were struggling to contain outbreaks of the coronavirus when its leaders went seeking new properties, state health records show. At a Virginia nursing home, staff hosted a hallway dance party for residents in April, weeks after federal guidelines had cautioned against such events. Conditions were so bad at one North Carolina facility that it was placed on a federal watch list even after the Centers for Disease Control and Prevention dispatched a strike team to help.

At its new nursing homes in Maryland, Portopiccolo’s operating companies made major changes to insurance and time-off benefits, failed to buy enough supplies and protective equipment and asked some employees to keep working after testing positive for coronavirus, said 14 current and former employees from four of the eight facilities.

Many veteran staffers quit as a result of the changes, said the employees, most of whom spoke on the condition of anonymity because they feared reprisals. Those who remained found themselves tending to dozens of residents at a time, the employees said.

“It was hair on fire,” said Katrina Pearthree, a former social worker at two facilities purchased by Portopiccolo over the last 15 months. She resigned from her job after losing health insurance coverage and disagreeing with new managers on patient care.

Portopiccolo spokesman John Collins denied that caregiving suffered and said that while benefits changed, they remained competitive within the industry. The firm, he said, wants to fill the gap left by nursing home owners exiting the industry because of the pandemic.

“Our company was founded by people who share a passion for caring for the sick, elderly and forgotten,” Collins said in a statement. “Any attempts to characterize our work or the work of our teams differently is flat out wrong.”

Elder-care advocates say Portopiccolo’s record of fines at other facilities, and the timing of its acquisitions, should have raised red flags for regulators, especially as the virus decimated the country’s nursing home population.

But the Centers for Medicare and Medicaid Services (CMS), the main federal agency regulating nursing homes, said the only way it tracks ownership changes is when facilities report the information for Medicare enrollment.

President-elect Joe Biden has said he wants to increase federal oversight through mandatory audits of nursing home cost reports and ownership data. Typically, such monitoring has fallen to state regulators, said Charlene Harrington, a professor emerita of sociology and nursing at the University of California at San Francisco. But even before the coronavirus crisis, she said, most states did a poor job.

In Maryland, the commission that oversees changes in nursing home ownership said the sale of a facility requires little more than “timely notification.” Virginia officials said they don’t closely monitor such sales, either.

“Your history indicates what you’re going to do in the future,” said Richard Mollot, executive director of a national advocacy group called the Long Term Care Community Coalition. “There needs to be more oversight of these purchases.”

‘From bad to worse’

Portopiccolo founders Simcha Hyman, 31, and Naftali Zanziper, 38, bought their first nursing home in 2016 after selling their medical supplies company to a private equity firm. They have since purchased more than 70 facilities in nine states, including 18 in Virginia. The nursing homes are run by operating companies set up and financed by the firm, including Peak Healthcare, Accordius Health and Pelican Health — a trend first reported by the business magazine Barron’s.

For years, Hyman and Zanziper described Portopiccolo as a private equity firm. But that description, along with the group’s promise to swiftly turn “distressed assets” profitable, was removed from the Portopiccolo website in early December after inquiries from The Washington Post about the firm’s nursing home acquisitions.

Collins said the label “private equity” — which typically describes groups that raise funding from private investors — is inaccurate. He declined to explain why the group described itself that way for months, including in news releases, and still does on its LinkedIn page.

Atul Gupta, a professor of health-care management at the Wharton School at the University of Pennsylvania, said it is possible Portopiccolo is trying to rebrand itself because of the increasingly negative stigma tied to private equity groups — which have been criticized for slashing costs at nursing homes, then selling them off to new owners. Studies, by Gupta and others, show that private equity ownership correlates with declines in staffing and quality of care.

Collins declined to say how many facilities Portopiccolo owns, how many it has sold or how much the firm has profited. Neither Peak Healthcare nor Accordius Health responded to multiple requests for comment.

An analysis of federal data shows that nearly 70 percent of facilities Portopiccolo owned before the pandemic have Medicare ratings of one or two stars out of five — based on patient-care metrics such as staffing ratios and infection control.

Two Portopiccolo facilities last month were placed in a federal monitoring program for having “a history of serious quality issues”; two others were listed as candidates because of severe deficiencies. Prior to the pandemic, the firm’s facilities in North Carolina were fined more than $480,000 for violating state and federal rules, federal data shows.

One facility placed in the monitoring program was the Citadel Salisbury, a one-star nursing home in Salisbury, N.C., where more than 150 staff and residents have contracted the virus, according to state data. Employees and residents alleged in a lawsuit filed in Rowan County Superior Court that Portopiccolo, which bought the facility from Genesis HealthCare on Feb. 1, left the nursing home woefully unprepared for the pandemic.

Employees testified in sworn affidavits that managers from Accordius, the operating group, prohibited staff from wearing masks in March, saying that doing so would scare residents. Nurses sometimes had to care for more than 50 residents at a time, employees alleged.

The lawsuit asks that the facility be required to improve conditions or be closed or put under new ownership. But lawyers for Portopiccolo asserted that staffing and equipment have been adequate. Hyman, Zanziper and Accordius executives sought to downplay their role at the Citadel, claiming in a motion to dismiss that daily operations were the responsibility of staff on site.

At the same time, Portopiccolo sued the families in federal court, arguing that they had signed agreements that preclude litigation against the nursing home.

Such arbitration clauses have become increasingly common at for-profit nursing homes, studies show, and have been criticized by consumer advocates as well as lawmakers as a way for facilities to avoid accountability. Biden said he wants to restore an Obama-era ban on the practice that was overturned by the Trump administration.

In June, North Carolina officials identified a slew of violations at the Citadel that they said placed residents in immediate jeopardy,” including a systemic failure to control infection and failing to inform the families of those who tested positive. Some found out their relatives had the virus from an emergency room physician. One man said he learned his aunt had died only when a funeral director called, asking what to do with her body.

Two hundred miles away in Virginia, staff shortages at Accordius Health in Harrisonburg were so dire before the pandemic that residents sometimes went days without showers, inspection records show.

“This place has gone from bad to worse,” one resident told an inspector. “They cut costs at our expense.”

After Accordius took over the facility in 2019, Ruth Simmers-Domzalski said, she noticed fewer staff members tending to her mother-in-law, Mary Domzalski, whose family twice found her lying on soiled bedsheets. On April 6, the facility held a hallway dance party where residents interacted without masks.

Domzalski, 88, attended. Three weeks later, she died of covid-19.

When asked about the event, Collins said the dance party did not conflict with federal guidelines at the time. CMS said on April 2 that all nursing home residents should cover their noses and mouths while interacting with staff; nearly a month before, it told facilities to cancel all group activities.

Tumultuous takeovers

Portopiccolo declined to say how many nursing homes it has bought during the pandemic, but The Post used CMS records to identify at least 22 facilities — eight in Maryland — that reported that Hyman and Zanziper had become owners since April.

Three of the Maryland facilities were bought from Genesis HealthCare, one of the largest skilled-nursing operators in the country. Amid plummeting occupancy rates and ballooning expenses, Genesis told stockholders this year that the firm would “improve its liquidity position” by selling off nearly two dozen of its roughly 400 nursing homes.

One was the Sligo Creek Center in Takoma Park, Md., where Pearthree, 59, worked part time as a social worker.

She had spent 18 years full time at another Genesis nursing home, the Fox Chase Rehabilitation Center in Silver Spring, leaving months after Portopiccolo bought it in 2019.

That sale was a “nightmare,” said Pearthree, recalling that new managers failed to secure local suppliers, leaving employees scrambling for medication and food. One afternoon, she said, staff members were unable to access digital patient records because Peak Healthcare had not put a new software system in place.

Less than a year after she left Fox Chase, Pearthree found herself facing another Portopiccolo takeover — this time amid a pandemic.

Again, the transition was chaotic. Peak did not actively recruit employees or offer them competitive packages prior to the takeover, leading to the departure of longtime staffers, including the administrator and director of nursing, said Pearthree and a senior Sligo Creek employee who spoke on the condition of anonymity because she feared reprisals. The former administrator and director of nursing did not respond to requests for comment.

Pearthree, a graduate student who worked 30 hours a week, was told she would have to increase her hours to keep her health insurance, she and Collins said.

Pearthree and the current employee also said Peak stopped providing hazard pay for contract employees and laid off a group of nonmedical staff Genesis had assembled to take temperatures and wipe down surfaces at the onset of the pandemic.

The facility has been cited twice by Maryand regulators since Peak took over, state inspection records show — in June for failing to test all residents and staff, and in August for failing to consistently inform family members of viral outbreaks.

Collins said staffing gaps were part of a nationwide shortage of nursing home workers and disputed the accounts from Pearthree and the current employee, saying supplies at both Sligo and Fox Chase were adequate and benefits were fair.

Eleven workers at three other Maryland nursing homes acquired by Portopiccolo during the pandemic said they lost paid time off and were offered more limited insurance packages. One worker who has asthma and high blood pressure said her bimonthly health insurance co-pay increased from $67 to $113 when Peak took over.

At Peak Healthcare Chestertown, on Maryland’s Eastern Shore, employees said the company offered a more limited benefits package than the facility’s previous owners, Autumn Lake, including less paid time off for new employees and no paid time off on major holidays.

The company scrimped on supplies, including cutlery, cleaning materials and clothing for residents, said employees at three facilities, who also spoke on the condition of anonymity out of fear of retribution.

Three employees at another facility said nurses have had to use hand soap to clean residents and rip up towels or bedsheets to dry them off.

“We risk our lives every day, and we don’t have proper supplies,” said one geriatric nursing assistant who brings her own gloves to work. “At what point do we put the patients first?”

Collins denied there were shortages, adding that at Chestertown, the budget for supplies had actually increased. He also denied that employees lost time off to which they were entitled, but said he could not address specific claims without knowing the names of the employees.

Reducing operating costs appears to be part of Portopiccolo’s business strategy, according to documents reviewed by The Post. In 2019, while acquiring three nursing homes in North Carolina, the group said it expected to save $360,000 by lowering expenses associated with employee benefits and insurance and $410,000 by cutting equipment and transportation costs. These measures, outlined in a mortgage loan contract, had allowed Portopiccolo to save more than $50 million across 37 facilities.

Collins said Portopiccolo has invested more than $6.7 million to purchase cleaning supplies and protective equipment since the start of this year. In comparison, Genesis, which operates about three times as many nursing homes, said that as of September, it had spent about $40 million more than normal on cleaning supplies and protective equipment.

Little government scrutiny

A recent study by the Long Term Care Community Coalition identified 15 states as having some good oversight practices for nursing home purchases, including requiring companies to disclose what other assets they own. Of the nine states in which Portopiccolo operates, none made the list.

“If your facilities in other states have very low staffing or a history of citations, you should not be allowed to purchase another one,” said Mollot, executive director of the coalition. “But states have a very hands-off approach to anything that happens outside their borders.”

Maryland Department of Health spokesman Charles Gischlar said the agency saw “no reason to change” the way it tracks shifts in nursing home ownership during the pandemic.

The Maryland Health Care Commission, another entity meant to oversee the sale of nursing homes, last year started asking prospective owners to affirm that they have not been convicted of a felony within the past 10 years or penalized more than $10 million because of their ownership of nursing homes.

But this requirement, which was designed “to keep out poor performers,” has not deterred a single transaction, said Paul Parker, a director at the commission.

For each facility that Hyman and Zanziper bought in Maryland, they declared to state regulators that they would not make substantive changes to services, staffing or bed ratios. State officials did not respond to questions asking how they ensured this would be true.

Gupta, the Wharton professor, said there should have been a moratorium on nursing home sales when the pandemic started because the changes that follow any acquisition can hamper a facility’s pandemic response.

But federal and state lawmakers never considered such a move.

“Nobody knew what was going on, nobody was in control,” Gupta said.

Joani Latimer, Virginia’s long-term-care ombudsman, said her office has been concerned by Portopiccolo’s pattern of buying facilities with low CMS ratings. Such facilities need more investment — not less — for conditions to turn around, she said.

“It’s not a process that you can just streamline to machine-like efficiency,” she said. “These are human needs with human challenges.”

Officials at the Virginia Department of Health, however, said they did not pay particular attention to Portopiccolo’s acquisition this year of Accordius Health at Courtland in Southampton County and Accordius Health at Waverly in Sussex County.

Such deals are “a business decision between the parties involved,” said Kimberly Beazley, director of the state Office of Licensure and Certification. “And we do not regulate business decisions made by facilities.”

Weeks with no hot water

Multiple employees at Portopiccolo-owned facilities, including one who worked in the kitchen at Chestertown, said their new managers had so much trouble filling staffing gaps this spring that employees were asked to work after learning they had the virus.

“It was a disaster,” said the Chestertown employee, who said she tested positive May 15 and declined when asked to come to work three days later. “People were still testing positive, and we were being asked to reapply for our jobs because this new company was coming in.”

Kent County Health Officer William Webb said local officials intervened that month after learning that a different employee at the facility who also had coronavirus was still working. “It was very concerning to me at the time, and we made sure to put a stop to it,” he said.

The facility’s water heater was broken from July to September, which meant there was no hot water for dishes or hand-washing. State inspectors fined the facility $730,000 for not fixing or reporting the problem, which they said posed “immediate jeopardy” to residents’ health. Collins said the firm is disputing the fine.

Webb said Peak’s decision not to promptly replace the water heater was “especially difficult” because the facility had seen scores of coronavirus cases and more than a dozen deaths in April and May. “If you’re in the business,” he said, “[you know] ample hot water is the core of any infection prevention program.”

When Peak took over managing the facility, roommates Patricia Sparkman, 82, and Brenda Middleton, 79, were isolated in their ground-floor room after testing positive for the virus.

Sparkman said in an interview that staff members left after the transition. Those who remained seemed less able to help, she said, including with basic tasks like bringing her water.

Middleton’s daughter, Tina Hurley, said the family moved Middleton a few months later to Peak Healthcare at Denton, about 30 miles away, so they could visit more frequently. But that facility had also been acquired by Portopiccolo on May 1.

Hurley said her mother is rarely checked on in Denton and has fallen several times while trying to get things for herself. At one point, she added, Middleton injured her leg but went without care from the facility’s doctor for days.

“I wouldn’t have brought her here if I knew how bad it would be,” Hurley said.

For Pearthree, the social worker at Sligo Creek, the breaking point came when she was asked to transfer back to Fox Chase in mid-May as director of social work. By then, Peak was operating both facilities.

She found residents she had known for years alone in their rooms, she said, confused and despondent in some cases. Relatives of those who died, she added, were given little information about how or when their loved ones had gotten sick.

When she raised concerns with managers, she said, she was brushed aside.

“The families felt betrayed by us,” Pearthree said. “And that was the part that overwhelmed me.” She sent a resignation letter in June.

Collins said Fox Chase administrators were unaware of her resignation and said Pearthree was terminated after she stopped coming to work. But the executive director of Fox Chase left Pearthree a voice mail on June 3 acknowledging her resignation and pleading with her to return.

“You do your job great and I like that,” the director said in the voice mail, which Pearthree shared with The Post.

Collins said that Portopiccolo leaders see their employees as “health care heroes.”

“We remain committed to putting care first,” he added.

Days before Thanksgiving, as all but one of the firm’s Maryland facilities reported new coronavirus outbreaks to the state, the firm closed on deals worth $37.7 million to acquire four more facilities in Florida.

StoneBridge Healthcare Makes Bid to Acquire Care New England Health System

https://www.prnewswire.com/news-releases/stonebridge-healthcare-makes-bid-to-acquire-care-new-england-health-system-301187518.html

StoneBridge Healthcare Makes Bid to Acquire Care New England Health System

Letter of Intent offered to acquire Rhode Island-based Care New England Health System

StoneBridge Healthcare, LLC (StoneBridge), an innovative company formed to buy, save and turn around distressed hospitals in the cities and suburbs of America, today announced it has presented a Letter of Intent (LOI) to purchase Rhode Island-based Care New England Health System. StoneBridge would make a significant investment in order to financially stabilize Care New England to allow the health system to continue its mission to transform the future of health care for the communities it serves.

“Care New England Health System has provided outstanding care to its patients for many years, and StoneBridge Healthcare is committed to the continuation of this high standard of care in Rhode Island,” said Joshua Nemzoff, Chief Executive Officer, StoneBridge Healthcare. “We believe that StoneBridge Healthcare is in a strong position to help Care New England to continue delivering cutting-edge care to the communities it serves for years to come.”

StoneBridge has offered a transaction value of $550 million with a purchase price of $250 million and a $300 million investment in capital improvements over six years to further transform the health system. The offer that StoneBridge has submitted includes a provision that will fully fund the employee’s pension plan at closing – a plan that is currently underfunded by more than $125 million. Care New England hospitals include the following: Butler Hospital, Kent Hospital, Women & Infants Hospital of Rhode Island, Care New England Medical Group, the VNA of Care New England, The Providence Center, and a certified accountable care organization (ACO) Integra.

“As the cost of care has risen and the COVID-19 pandemic has placed a tremendous strain on health systems across the nation, StoneBridge Healthcare is ready to assist Care New England during these challenging times to continue delivering an outstanding continuum of care to the region,” Nemzoff added. “StoneBridge Healthcare has the expertise and financial resources needed to help lead Care New England to a promising future.”

The LOI is not binding, and a Definitive Agreement would be finalized in a short period of time once comprehensive due diligence is performed. StoneBridge is a privately-owned company capitalized through a multi-layered composite finance group that includes nationally known debt and equity sources.

Earlier this year, StoneBridge submitted an offer to acquire the Erlanger Heath System in Tennessee for a transaction value of $475 million. StoneBridge is actively pursuing discussions related to this transaction, which is a system of similar size to Care New England and has also been devastated by the impact of the COVID-19 pandemic.

About StoneBridge Healthcare
StoneBridge Healthcare is an innovative company formed to buy, save and turn around deeply distressed hospitals in the cities and suburbs of America. StoneBridge is capitalized through a multi-layered composite finance group that includes nationally known debt and equity sources. The company features a nationally recognized team of experts in healthcare operations, finance, acquisitions and turnarounds.

Our decades of experience, our financial investment and our commitment to expand primary care into the urban areas we serve make our company the only one of its kind. StoneBridge Healthcare plans to purchase and turn around acute care hospitals that are in significant economic distress and could otherwise be forced to close. StoneBridge will identify and buy hospitals that can be saved, and then work urgently to make sure these hospitals survive and succeed.

StoneBridge is committed to responding to the healthcare needs of the urban markets it operates in through an initiative that is known as “The Mission Project.” Using the hospitals it acquires as a base of operations, StoneBridge will bring much-needed services into the community. StoneBridge will listen to and work with local groups to understand the gaps in community care – and then put money and time into offering clinics or other life-changing help. The solutions may look different in each market, but the commitment will be consistent. The hospitals can provide the doctors, nurses, pharmacies, kitchens and vehicles to bring care and support to people where they live. For more information please visit: stonebridgehealthcare.com.

A growing number of Americans are going hungry

A growing number of Americans are going hungry – Washington Sources

26 million now say they don’t have enough to eat, as the pandemic worsens and holidays near.

It was 5 a.m., not a hint of sun in the Houston sky, as Randy Young and his mom pulled into the line for a free Thanksgiving meal. They were three hours early. Hundreds of cars and trucks already idled in front of them outside NRG Stadium. This was where Young worked before the pandemic. He was a stadium cook. Now, after losing his job and struggling to get by, he and his 80-year-old mother hoped to get enough food for a holiday meal.

“It’s a lot of people out here,” said Young, 58. “I was just telling my mom, ‘You look at people pulling up in Mercedes and stuff, come on.’ If a person driving a Mercedes is in need of food, you know it’s bad.”

More Americans are going hungry now than at any point during the deadly coronavirus pandemic, according to a Post analysis of new federal data — a problem created by an economic downturn that has tightened its grip on millions of Americans and compounded by government relief programs that expired or will terminate at the end of the year. Experts say it is likely that there’s more hunger in the United States today than at any point since 1998, when the Census Bureau began collecting comparable data about households’ ability to get enough food.

One in 8 Americans reported they sometimes or often didn’t have enough food to eat in the past week, hitting nearly 26 million American adults, an increase several times greater than the most comparable pre-pandemic figure, according to Census Bureau survey data collected in late October and early November. That number climbed to more than 1 in 6 adults in households with children.

“It’s been driven by the virus and the unpredictable government response,” said Jeremy K. Everett, executive director of the Baylor Collaborative on Hunger and Poverty in Waco, Tex.

Nowhere has there been a hunger surge worse than in Houston, with a metro-area population of 7 million people. Houston was pulverized in summer when the coronavirus overwhelmed hospitals, and the local economy was been particularly hard hit by weak oil prices, making matters worse.

More than 1 in 5 adults in Houston reported going hungry recently, including 3 in 10 adults in households with children. The growth in hunger rates has hit Hispanic and Black households harder than White ones, a devastating consequence of a weak economy that has left so many people trying to secure food even during dangerous conditions.

On Saturday, these statistics manifested themselves in the thousands of cars waiting in multiple lines outside NRG Stadium. The people in these cars represented much of the country. Old. Young. Black. White. Asian. Hispanic. Families. Neighbors. People all alone.

Inside a maroon Hyundai Santa Fe was Neicie Chatman, 68, who had been waiting since 6:20 a.m., listening to recordings of a minister’s sermon piped into large earphones.

“I’ve been feeding my spirit,” she said.

Her hours at her job as an administrator have been unsteady since the pandemic began. Her sister was laid off. They both live with their mother, who has been sick for the past year. She planned to take the food home to feed her family and share with her older neighbors.

“It’s been hard to survive. Money is low. No jobs. Hard to find work.”

— Randy Young

“I lost my business and I lost my dream.”

— Adriana Contreras

Now, a new wave of coronavirus infections threatens more economic pain.

Yet the hunger crisis seems to have escaped widespread notice in a nation where millions of households have weathered the pandemic relatively untouched. The stock market fell sharply in March before roaring back and has recovered all of its losses. This gave the White House and some lawmakers optimism about the economy’s condition. Congress left for its Thanksgiving break without making any progress on a new pandemic aid deal even as food banks across the country report a crush of demand heading into the holidays.

“The hardship is incredibly widespread. Large parts of America are saying, ‘I couldn’t afford food for my family,’ ” said Stacy Dean, who focuses on food-assistance policy at the Center on Budget and Policy Priorities. “It’s disappointing this hasn’t broken through.”

No place has been spared. In one of the nation’s richest counties, not far from Trump National Golf Club in Virginia, Loudoun Hunger Relief provided food to a record 887 households in a single week recently. That’s three times the Leesburg, Va.-based group’s pre-pandemic normal.

“We are continuing to see people who have never used our services before,” said Jennifer Montgomery, the group’s executive director.

Hunger rates spiked nationwide after shutdowns in late March closed large chunks of the U.S. economy. The situation improved somewhat as businesses reopened and the benefits from a $2.2 trillion federal pandemic aid package flowed into people’s pockets, with beefed-up unemployment benefits, support for food programs and incentives for companies to keep workers on the payroll.

But those effects were short-lived. The bulk of the federal aid had faded by September. And more than 12 million workers stand to lose unemployment benefits before year’s end if Congress doesn’t extend key programs.

“Everything is a disaster,” said Northwestern University economist Diane Whitmore Schanzenbach, a leading expert on the economics of food insecurity. “I’m usually a pleasant person, but this is just crazy.”

Economic conditions are the main driver behind rising rates of hunger, but other factors play a role, Schanzenbach said. In the Great Recession that began in 2008, people received almost two years of unemployment aid — which helped reduce hunger rates. Some long-term unemployed workers qualified for even more help.

But the less-generous benefits from the pandemic unemployment assistance programs passed by Congress in March have already disappeared or soon will for millions of Americans.

Even programs that Congress agreed to extend have stumbled. A program giving families additional cash assistance to replace school meals missed by students learning at home was renewed for a year on Oct. 1. But the payments were delayed because many states still needed to get the U.S. Agriculture Department’s approval for their plans. The benefit works out to only about $6 per student for each missed school day. But experts say the program has been a lifeline for struggling families.

One program that has continued to provide expanded emergency benefits is the Supplemental Nutrition Assistance Program, or SNAP. The Agriculture Department issued an emergency order allowing states to provide more families the maximum benefit and to suspend the time limit on benefits for younger unemployed adults without children.

The sharpest rise in hunger was reported by groups who have long experienced the highest levels of it, particularly Black Americans. Twenty-two percent of Black U.S. households reported going hungry in the past week, nearly twice the rate faced by all American adults and more than two-and-a-half times the rate for White Americans.

The Houston area was posting some of its lowest hunger rates before the pandemic, thanks to a booming economy and a strong energy sector, Everett said. Then, the pandemic hit. Hunger surged, concentrated among the city’s sizable low-income population, in a state that still allows for the federally mandated minimum wage of $7.25 an hour. Houston’s hunger rates — like those nationwide — fell significantly after the $1,200 stimulus checks were mailed out in April and other pandemic aid plans took effect, Everett said.

But most of the effects of that aid are gone.

“Without sustained aid at the federal level, we’ll be hard pressed to keep up,” said Celia Call, chief executive of Feeding Texas, which advocates for 21 food banks in the state. “We’re just bracing for the worst.”

Schools are one of the most important sources of food for low-income families in Houston. The Houston Independent School District has 210,000 students — many of whom qualify for free or reduced-priced meals. But the pandemic closed schools in the spring. They reopened in the fall with less than half of the students choosing a hybrid model of in-school and at-home instruction. That has made feeding these children a difficult task.

“We’ve made an all-out effort to capture these kids and feed them,” said Betti Wiggins, the school district’s nutrition services officer.

The district provided curbside meal pickups outside schools. Anyone could come, not just schoolchildren. School staffers set up neighborhood distribution sites in the areas with the highest need. They started a program to serve meals to children living in apartment buildings. Sometimes the meal program required police escorts.

“I’m doing everything but serving in the gas station when they’re pumping the gas,” Wiggins said.

Wiggins said the normal school meals program she ran before the pandemic has been transformed into providing food for entire families far beyond a school’s walls. She has noticed unfamiliar faces in her meal lines. The “new poor,” she calls them, parents who might have worked in the airline or energy industries crushed by the pandemic.

“I’m seeing folks who don’t know how to handle the poverty thing,” she said, adding that it became her mission to make sure they had food.

The Houston Food Bank is the nation’s largest, serving 18 counties in Southeast Texas with help from 1,500 partner agencies. Last month, the food bank distributed 20.6 million pounds of food — down from the 27.8 million pounds handed out in May, but still 45 percent more than what it distributed in October 2019, with no end in sight.

The biggest worry for food banks right now is finding enough food, said Brian Greene, president of the Houston Food Bank. Food banks buy bulk food with donations. They take in donated food items, too. Food banks also benefited from an Agriculture Department program that purchased excess food from U.S. farmers hurt by the ongoing trade war with China, typically apples, milk and pork products. But funding for that program ended in September. Other federal pandemic programs are still buying hundreds of millions of dollars in food and donating it to food banks. But Greene said he worries about facing “a commodity cliff” even as demand grows.

Teresa Croft, who volunteers at a food distribution site at a church in the Houston suburb of Manvel, said the need is still overwhelming. She handles the paperwork for people visiting the food bank for the first time. They’re often embarrassed, she said. They never expected to be there. Sometimes, Croft tries to make them feel better by telling her own story — how she started at the food bank as a client, but got back on her feet financially more than a decade ago and is now a food bank volunteer.

“They feel so bad they’re having to ask for help. I tell them they shouldn’t feel bad. We’re all in this together,” Croft said. “If you need it, you need it.”

The pandemic changed how the Houston Food Bank runs. Everything is drive-through and walk-up. Items are preselected and bagged. The food bank has held several food distribution events in the parking lots outside NRG Stadium — a $325 million, retractable-roof temple to sports and home to the National Football League’s Houston Texans.

Last weekend, instead of holding the 71st annual Thanksgiving Day Parade in Houston, the city and H-E-B supermarkets decided to sponsor the food bank’s distribution event at NRG Stadium. The plan was to feed 5,000 families.

The first cars arrived at the stadium around 1 a.m. Saturday, long before the gates opened for the 8 a.m. event. By the time Young and his mother drove up, the line of vehicles stretched into the distance. Organizers opened the gates early. The cars and trucks began to slowly snake through the stadium’s parking lot toward a series of white tents, where the food was loaded into trunks by volunteers. The boxes contained enough food for multiple meals during the holiday week, with canned vegetables such as corn and sweet potatoes, a package of rolls, cranberry sauce and a box of masks. People picking up food were also given a bag of cereal and some resealable bags, a ham, a gallon of milk, and finally a turkey and pumpkin pie.

The food for 5,000 families ran out. The Houston Food Bank — knowing that would not be enough — was able to assemble more.

It provided food to 7,160 vehicles and 261 people who walked up to the event.

Troy Coakley, 56, came to the event looking for food to feed his family for the week. He still had his job breaking apart molds at a plant that makes parts for oil field and water companies. But his hours were cut when the economy took a hit in March. Coakley went from working overtime to three days a week.

He was struggling. Behind on rent. Unsure what was to come.

But for the moment, his trunk filled with food, he had one less thing to worry about.

“Other than [the pandemic], we were doing just fine,” Coakley said. “But now it’s getting worse and worse.”

Tenet to lay off workers in Detroit, shed 4 urgent care centers

https://www.beckershospitalreview.com/finance/tenet-to-lay-off-workers-in-detroit-shed-4-urgent-care-centers.html?utm_medium=email

Tenet's Detroit Medical Center plans for more job cuts

Detroit Medical Center is laying off employees, and its parent company, Dallas-based Tenet Healthcare, is planning to sell or close four urgent care centers in the Detroit area, according to Crain’s Detroit Business

Detroit Medical Center officials told Crain’s layoffs have occurred, but they declined to disclose the number of employees affected. Sources told Crain’s several hundred DMC employees have been laid off with more expected this year. Clinical staff, administrative assistants and employees at the management level were reportedly affected by the layoffs. 

“Like many health systems locally and nationally, we continually evaluate and review our staffing needs, which have decreased due to reduced patient demand during the pandemic,” DMC said in a statement to Becker’s Hospital Review. “Our goal is to ensure we are strongly positioned to provide the highest quality and safest care to our patients while making the best use of our resources.”

Tenet is also planning to sell or close its four remaining MedPost urgent care centers in the Detroit area. Tenet has reached agreements to sell three of the urgent care centers in Bloomfield, Livonia and Southfield, Mich., to First Choice Urgent Care, a company spokesperson told Becker’s Hospital Review

“We expect all employees in good standing to be offered positions to remain at the facilities upon completion of the sale, which we anticipate occurring in December,” the spokesperson told Becker’s

The MedPost urgent care center in Rochester Hills, Mich., will close in December, the spokesperson said. Tenet may convert it to a physician office or other type of healthcare facility. 

“We are committed to providing our full support and assistance to employees through the close, and facilitating opportunities for open roles at local Tenet facilities,” the spokesperson told Becker’s

Tenet, a 65-hospital system, operated nine MedPost urgent care centers in the Detroit area at the beginning of the year. It closed five of the centers in April due to challenges linked to the COVID-19 pandemic. The MedPost urgent care centers are not part of DMC. 

Genesis Healthcare warns of possible bankruptcy

https://www.beckershospitalreview.com/finance/genesis-healthcare-warns-of-possible-bankruptcy.html?utm_medium=email

News

Kennett Square, Pa.-based Genesis Healthcare, one of the largest post-acute care providers in the U.S., warned that bankruptcy is possible if its financial losses continue. 

“The virus continues to have a significant adverse impact on the company’s revenues and expenses, particularly in hard-hit Mid Atlantic and Northeastern markets,” Genesis CEO George V. Hager Jr., said in a Nov. 9 earnings release.

Mr. Hager said government stimulus funds the company received in the third quarter of this year fell nearly $60 million short of the company’s COVID-19 costs and lost revenue. 

Genesis said it has taken several steps to help offset the financial damage linked to the pandemic, including delaying payment of a portion of payroll taxes incurred through December. 

But the company warned that bankruptcy is possible if its financial losses continue. 

“Even if the company receives additional funding support from government sources and/or is able to execute successfully all of its these plans and initiatives, given the unpredictable nature of, and the operating challenges presented by, the COVID-19 virus, the company’s operating plans and resulting cash flows, along with its cash and cash equivalents and other sources of liquidity. may not be sufficient to fund operations for the 12-month period following the date the financial statements are issued,” Genesis said. “Such events or circumstances could force the company to seek reorganization under the U.S. Bankruptcy Code.”

Genesis ended the third quarter of this year with a net loss of $62.8 million, compared to net income of $46.1 million in the same period a year earlier. 

11 hospitals laying off workers

https://www.beckershospitalreview.com/finance/11-hospitals-laying-off-workers-110920.html?utm_medium=email

Layoffs costing hundreds of people their jobs in NC but notices don't  capture true scope of cuts | WRAL TechWire

The financial challenges caused by the COVID-19 pandemic have forced hundreds of hospitals across the nation to furlough, lay off or reduce pay for workers, and others have had to scale back services or close. 

Lower patient volumes, canceled elective procedures and higher expenses tied to the pandemic have created a cash crunch for hospitals. U.S. hospitals are estimated to lose more than $323 billion this year, according to a report from the American Hospital Association. The total includes $120.5 billion in financial losses the AHA predicts hospitals will see from July to December. 

Hospitals are taking a number of steps to offset financial damage. Executives, clinicians and other staff are taking pay cuts, capital projects are being put on hold, and some employees are losing their jobs. More than 260 hospitals and health systems furloughed workers this year and dozens of others have implemented layoffs. 

Below are 11 hospitals and health systems that announced layoffs since Sept. 1, most of which were attributed to financial strain caused by the pandemic. 

1. NorthBay Healthcare, a nonprofit health system based in Fairfield, Calif., is laying off 31 of its 2,863 employees as part of its pandemic recovery plan, the system announced Nov. 2. 

2. Minneapolis-based Children’s Minnesota is laying off 150 employees, or about 3 percent of its workforce. Children’s Minnesota cited several reasons for the layoffs, including the financial hit from the COVID-19 pandemic. Affected employees will end their employment either Dec. 31 or March 31.

3. Brattleboro Retreat, a psychiatric and addiction treatment hospital in Vermont, notified 85 employees in late October that they would be laid off within 60 days. 

4. Citing a need to offset financial losses, Minneapolis-based M Health Fairview said it plans to downsize its hospital and clinic operations. As a result of the changes, 900 employees, about 3 percent of its 34,000-person workforce, will be laid off.

5. Lake Charles (La.) Memorial Health System laid off 205 workers, or about 8 percent of its workforce, as a result of damage sustained from Hurricane Laura. The health system laid off employees at Moss Memorial Health Clinic and the Archer Institute, two facilities in Lake Charles that sustained damage from the hurricane.

6. Burlington, Mass.-based Wellforce laid off 232 employees as a result of operating losses linked to the COVID-19 pandemic. The health system, comprising Tufts Medical Center, Lowell General Hospital and MelroseWakefield Healthcare, experienced a drastic drop in patient volume earlier this year due to the suspension of outpatient visits and elective surgeries. In the nine months ended June 30, the health system reported a $32.2 million operating loss. 

7. Baptist Health Floyd in New Albany, Ind., part of Louisville, Ky.-based Baptist Health, eliminated 36 positions. The hospital said the cuts, which primarily affected administrative and nonclinical roles, are due to restructuring that is “necessary to meet financial challenges compounded by COVID-19.”

8. Cincinnati-based UC Health laid off about 100 employees. The job cuts affected both clinical and non-clinical staff. A spokesperson for the health system said no physicians were laid off. 

9. Mercy Iowa City (Iowa) announced in September that it will lay off 29 employees to address financial strain tied to the COVID-19 pandemic. 

10. Springfield, Ill.-based Memorial Health System laid off 143 employees, or about 1.5 percent of the five-hospital system’s workforce. The health system cited financial pressures tied to the pandemic as the reason for the layoffs. 

11. Watertown, N.Y.-based Samaritan Health announced Sept. 8 that it laid off 51 employees and will make other cost-cutting moves to offset financial stress tied to the COVID-19 pandemic.

What’s at stake in the ACA case

https://mailchi.mp/2480e0d1f164/the-weekly-gist-october-30-2020?e=d1e747d2d8

5 Key Points To Understanding New Court Skirmish Over Obamacare : Shots -  Health News : NPR

Since the Affordable Care Act (ACA) was signed into law a little more than a decade ago, it has fundamentally reshaped the American healthcare system. As the graphic below highlights, the far-reaching law expanded insurance coverage, increased consumer protections, led to new payment models, established minimum coverage standards, reformed the Indian Health Service—and even gave us calorie counts on menus, among myriad other things.

The fate of the ACA is once again in the Supreme Court’s hands—and the nine Justices, now including Amy Coney Barrett, are scheduled to hear arguments starting November 10th. Eighteen states with Republican leadership are asking the court to determine whether the individual mandate is constitutional without a financial penalty, and whether the mandate is severable from the rest of the law.
 
The process of unwinding a law that touches nearly every facet of the US healthcare system would mean a confusing and financially detrimental road ahead for many. Although we believe it’s unlikely that the entire law will be ruled unconstitutional, if it is—and no replacement legislation is passed—the effects could be devastating.

An estimated 21 million people would be at serious risk of losing their health insurance. This risk is magnified for Hispanic and Black Americans, who are also hardest hit by COVID-19. As many as 133M people with pre-existing conditions could face insurance disqualification or significantly higher premiums.

The lost coverage would result in a significant revenue hit for doctors and hospitals. While the impact would vary by state depending on Medicaid expansion terms, an Urban Institute report projects that total uncompensated care would grow an average of 78 percent for hospitals and 68 percent for physician services if the ACA is struck down. Although the Court is not expected to rule on the fate of the law until mid-2021, the direction and pace of future health reform legislation will be set by the ruling, under either a Trump or Biden administration.

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