CMA Alert | May 12, 2022

Join Us!

Join our community next week for the Center’s upcoming special virtual event, the 9th Annual National Voices of Medicare Summit & Senator Jay Rockefeller Lecture on Wednesday, May 18 via live webcast.

Together, we’ll examine how to best expand Medicare, the need for Medicare coverage for audiology and oral health care, and access to Medicare-covered home health care and rehabilitation services – looking at all through a health equity lens and interspersed with stories of real Medicare beneficiaries.

In addition, renowned journalist and university professor E.J. Dionne, Jr. will present the Senator Jay Rockefeller Lecture, and we are excited to celebrate a true champion of advocacy by honoring Attorney Wey-Wey Kwok with the Alfred J. Chiplin, Jr. Social Justice and Advocacy Award.

As one first-time Summit attendee said last year, “it was a learning experience I will never forget. It’s moving to see how you inspire each other, learn from each other, and forge partnerships together for a better tomorrow.”

We welcome you to visit our 2022 Summit webpage to see the full agenda, answers to FAQs about the event – and to sign up now in support of the Center for Medicare Advocacy. We would be tremendously grateful to have you join us.

Note: This program has been approved for continuing legal education credits for a maximum of 2.7 hours.

Fewer Residents Died from COVID in Unionized Nursing Homes

An observational study of 13,350 nursing homes between June 8, 2020 and March 21, 2021 finds that facilities with unionized workers were associated with a 10.8% lower COVID-19 mortality rate among residents and a 6.8% lower COVID-19 infection rate among workers. 

The study, “Resident Mortality And Worker Infection Rates From COVID-19 Lower In Union Than Nonunion US Nursing Homes, 2020-2021,” calculates that “industry-wide unionization would have been associated with approximately 8,000 fewer resident deaths.” The researchers suggest that policies advocated for by unions – paid sick leave, access to personal protective equipment and COVID testing, and isolation of infected residents – may decrease workers’ rates of infection, thereby lowering residents’ mortality. Among the 13,350 facilities in the study, 11,108 were non-union facilities and 2,242 were union facilities.

Unionized nursing facilities had higher percentages of Medicaid residents, higher occupancy rates, and fewer white residents than non-unionized facilities. They had higher registered nurse staff-to-resident ratios, but lower licensed practical nurse and certified nurse aide staff-to-resident ratios. Unionized facilities had higher rates of for-profit ownership, but lower percentages of chain affiliation.

• For further information: Adam Dean, et al, “Resident Mortality And Worker Infection Rates From COVID-19 Lower In Union Than Nonunion US Nursing Homes, 2020-2021, Health Affairs (May 2022), https://www.healthaffairs.org/doi/epdf/10.1377/hlthaff.2021.01687.

An Exploration of the Pandemic’s Full Impact on Racial and Ethnic Minorities from March to December 2020

The United States is on track to hit a grim COVID-19 milestone. Soon, over one million people will have lost their lives to the pandemic.[1]^,[2] While daily death rates have fallen, the average number of daily cases is back on the rise – increasing 49% in the past two weeks.[3] Throughout the pandemic, these case rates and death tolls have not been evenly distributed[4] – a pattern further expanded upon by the authors of a Research Letter recently published in JAMA Internal Medicine. The study attempts to explore the pandemic’s full, societal-level impact on mortality for racial and ethnic minority populations. The authors leveraged monthly death data for external causes of death (i.e., drug overdose, transportation, homicide, and suicide) from the Centers for Disease Control and Prevention.[5]

Starting with a forecast of expected deaths from external causes (which was derived from monthly death count data between January 2015 and February 2020), the researchers calculated the number of “excess deaths” from March to December 2020 by subtracting their forecasted death number from the number of actual observed deaths during that period.[6] Their findings revealed over 17,000 excess deaths from all external causes in the US. The researchers estimate these excess deaths were highest among Black and American Indian or Alaska Native individuals. Black individuals, furthermore, had the highest estimated excess homicide deaths per capita (6.7 per 100,000 population), which was more than double the rate of the next highest group (American Indian or Alaska Native individuals). [7] Meanwhile, excess transportation-related deaths (auto accidents, etc.) were only evident among Black and Hispanic individuals.

The researchers suggest that “the pandemic contributed to these disparities through both direct and indirect mechanisms.” Structural racism was identified as the root cause of the disparities in excess deaths from external causes. The researchers also note that discrimination against Black and American Indian or Alaska Native populations produced communities that were especially vulnerable to the consequences of the pandemic, such as unemployment, housing instability, and reduced access to health care. The authors emphasize the importance of addressing structural determinants of violence, substance abuse, and transportation deaths among racial and ethnic minority groups.

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[1] CDC. CDC COVID Data tracker. Centers for Disease Control and Prevention. (Updated May 11, 2022). Available at: from https://covid.cdc.gov/covid-data-tracker/#datatracker-home 
[2] Parker, J. E. The ‘five pandemics’ driving 1 million U.S. covid deaths. STAT. (May 10, 2022). Available at: https://www.statnews.com/2022/05/10/the-five-pandemics-driving-1-million-u-s-covid-deaths/ 
[3] The New York Times. Coronavirus in the U.S.: Latest Map and Case Count. (Updated May 10, 2022). Available at: https://www.nytimes.com/interactive/2021/us/covid-cases.html 
[4] CDC. Health Equity Considerations and Racial and Ethnic Minority Groups. Centers for Disease Control and Prevention. (Updated January 25, 2022). Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html [5] Ling, I., Del Rosario, M., & Gross, C. P. The COVID-19 Pandemic and Racial and Ethnic Disparities in Estimated Excess Mortality from External Causes. Editor’s Note. (May 9, 2022). Available at: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2791683?guestaccesskey=0e24d0b4-7d02-496b-a97b-4ac908f24fea&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=050922 
[6] Chen, R., Aschmann, H. E., & Chen, Y.-H. Racial and Ethnic Disparities in Estimated Excess Mortality from External Causes in the US, March to December 2020. JAMA Internal Medicine. (May 9, 2022). Available at: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2791682?widget=personalizedcontent&previousarticle=2791683 
[7] Ibid.

Improving Substance Abuse Care for Older Adults

A recent Health Affairs article, “To Care For Older Adults With Substance Use Disorder, Create Age-Friendly Health Systems” outlines improvements for screening, treatment and coordination of care for substance use disorders among older adults.

The article notes the scope of this issue, stating that there were more than 30,000 unintentional drug overdoses among adults ages 65 and older between 1999 and 2020, representing an almost 700% increase during the time frame.

The article emphasized the importance of care coordination for older adults who often have multiple chronic conditions and may see a number of providers and take various medications to treat those conditions. The article states:

For this population, the goal should be integrated and coordinated geriatric-based care that focuses on maintaining function and managing chronic conditions, including  geriatric conditions, in coordination with substance use disorder treatment. Fragmented care for older patients on methadone, especially for patients with multiple chronic conditions who take many medications, is not age-friendly and increases the likelihood of drug-drug and drug-disease interactions, common among people living with multimorbidity. As opioid treatment programs increasingly care for an aging population, integrating other needed services (for example, medical care, psychiatric care, nursing care, physical therapy, adult day services) into existing treatment programs could mitigate social isolation and reduce hospitalization and institutionalization.

The article also promotes expanded access to buprenorphine treatment for older adults, in addition to the other two Food and Drug Administration-approved medications methadone, and naltrexone to be used when appropriate; buprenorphine may be safer for some older adults with certain chronic diseases.

Among other suggestions, the article also calls for the COVID-19 expansion in telehealth for some substance use disorder treatments to be made permanent as they can “improve access to methadone for patients with functional impairments who may be home-bound or who have difficulties with transportation.”

FREE WEBINAR | Choosing the Medicare Option That’s Right For You When You Are Living With Paralysis

Wednesday June 1, 2022 @ 2 – 3:00 PM EDT

A Webinar for the Christopher and Dana Reeve Foundation by the Center for Medicare Advocacy, presented by Center for Medicare Advocacy Associate Directors Kathy Holt and David Lipschutz.

The program will explore the pros and cons of getting Medicare through the traditional public program or a private managed-care Medicare Advantage program, whether you’re:

• New to Medicare, 
• Seeking to change your Medicare option during the annual election period, or 
• Wondering if your changing life circumstances might present other opportunities for choosing how you get Medicare.

The presentation will also examine: 

• Resources to optimize the decision on how you get Medicare, 
• Strategies to avoid late enrollment penalties, 
• Coordinating insurance when you have other types of health coverage, in addition to Medicare, and
• Programs that may assist in paying for the costs of Medicare.

Register Now: https://attendee.gotowebinar.com/register/5475548536534188816