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January 14th, 2014

1/14/2014

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The ancient playwright Sophocles could not have written a political satire more robust than Maryland's current comedy/tragedy politics.  Maryland's 1% say-----this is no failure----we moved hundreds of millions of dollars to the connected people we chose!



THERE IS GOOD NEWS FROM THE FAILURE OF MARYLAND HEALTH SYSTEM DESIGNED TO END FEDERAL PROGRAMS MEDICARE, MEDICAID, AND PUBLIC SECTOR HEALTH PLANS.....PEOPLE HAVE TIME TO SEE THE DAMAGE AFFORDABLE CARE ACT DOES TO THE AMERICAN PEOPLE AND THEY ALL NOW WANT EXPANDED AND IMPROVED MEDICARE FOR ALL!

Do you hear your political pundit, labor and justice organization,or incumbent shouting out all of what I have been  saying about the Affordable CAre Act for 4 years?  Well, they knew what I knew and they were not working for you and me!

As I have said there are well-developed plans already developed for Expanded and Improved Medicare for All.  Any politician could run for Governor of Maryland and simply use existing policy and planning to implement.  Do not allow neo-liberals to tell you it can't be done because simply building oversight into Medicare health system will end 1/2 of expenditures just by ending fraud and profiteering!  This neo-liberals have wasted hundreds of billions of dollars developing this private system simply to make health care a global profit-maximizing industry and WE WILL TAKE IT BACK!!!!


I would like to end this session on health care reform with a reminder of how the State of Maryland moves to Expanded and Improved Medicare for All.


Still think the plan was not to end Medicare and Medicaid as Federal programs by sending them all to state health systems that dismantle all Federal protections for public health?

Private health plans have no intention of coming into these exchanges because they are well on their way to going global with the deregulation of the Affordable Care Act they will be just as unaccountable as Wall Street and just as criminal and corrupt.  What you see are private companies being created under the guise of private non-profits like EVERGREEN owned and run by Johns Hopkins under Beilenson.  So, these private non-profits will end up with all of Medicare, Medicaid, and public sector health plans ending these Federal programs and with deregulations and not public health protections....health care for most will become charity work if these people have their way.


ALL ACROSS THE  COUNTRY THE MOST HEALTH ACCOUNTS BEING CREATED ARE FOR MEDICAID....AS IN MARYLAND.



Tue, Jan 14, 2014, 8:28 AM EST -

63 percent of RI insurance sign-ups for Medicaid 63 percent of insurance sign-ups during first 3 months of HealthSource RI were for Medicaid

By Erika Niedowski, Associated Press 16 hours ago

HealthSource RI said that 11,770 individuals enrolled in commercial plans between Oct. 1, when the marketplace opened, and Jan. 4. The state Health and Human Services office said 19,941 enrolled in Medicaid during the same period.

Of those who enrolled for private coverage, 9,902 have paid and had coverage begin this month, according to HealthSource RI.

The marketplace, sometimes known as an exchange, also released new demographic data that show who is using it and what type of coverage they are choosing.

One-third of individual private-plan enrollees are 55 and older; 23 percent are 18 to 34. The overwhelming majority of those who signed up chose a Blue Cross & Blue Shield of Rhode Island plan. Fifty-six percent chose a "silver" plan over bronze, gold and platinum.

Eighty-seven percent are receiving some kind of subsidies for the coverage.

It's not clear how many of those who enrolled in private plans were previously uninsured.

Most Americans are now required to have health insurance under the federal Affordable Care Act, or pay a penalty. There are more than 120,000 uninsured in Rhode Island in a population of just over 1 million.

The state has not publicly released enrollment targets for the first sign-up period, but the U.S. Centers for Medicaid and Medicare Services set a goal of 5,640 enrollments in Rhode Island by Dec. 31 and 12,000 by March 31.

HealthSource RI also reported Monday that 75 small businesses have enrolled, representing 530 employees. The state is putting a lot of emphasis on getting small businesses to sign up.

The marketplace is offering 12 individual plans and 16 small-group plans in 2014.

The deadline to pay for coverage beginning Jan. 1 already passed, but open enrollment is continuing through March 31. The next deadline to select and pay for a plan is Jan. 23.

________________________________________

Did you know that HUMANA is a private health plan that seeks to draw seniors out of the public Medicare by front-loading these plans with perks but in the longer term will undermine this strong Federal program and it is deliberate?

If people understand what Maryland's Medicare exemption from Federal oversight means you will see why Hopkins is tied with a private senior health care corporation.  Hopkins' goal in health policy is to maximize health profits and when they requests these exemptions from Medicare they are telling us they are making Medicare more cost effective.  What they are doing is creating the tiered system of payments to Medicare patients and procedures that has systematically made Maryland's hospitals the worst in the nation as far as quality care and performance.  Just finished surgery on you leg under anesthesia and still haven't fully woken from this procedure after a few hours?


TOO BAD BECAUSE YOUR TIME IS UP AND YOU ARE OUT THE DOOR.  WHAT???  NO ONE AT HOME TO MAKE SURE YOU HAVE NO ILL EFFECTS FROM THE SURGERY?  HIRE A HOME HEALTH PERSON TO COME SIT WITH YOU ---YOUR TIME IS UP HERE IN MEDSTAR!!!!


We had surgery and implanted a steel plate for your broken bone that once simply had a cast placed on it because the bone had a fracture that needed support.  The patient asks to see the X-RAY and straining his eyes looking for a fracture because there is none is told by the doctor-----IT'S THERE!

Need a doctor that handles Medicare?????  There is a compound for senior care on the outskirts of the city with national health chains.....GO THERE! 


This is how Hopkins has made Maryland's health businesses the most profitable in the nation and these new approaches are what the Affordable Care Act is based upon.  It is diabolical!!!!

I DO NOT HAVE TO TELL BALTIMORE CITIZENS THAT PEOPLE ARE FEARFUL OF ENTERING JOHNS HOPKINS AND CALL MEDSTAR A DEATH TRAP BECAUSE OF WHAT THESE LONG-TERM HEALTH POLICIES HAVE DONE TO MARYLAND'S HEALTH SYSTEM....SO, AS HOPKINS TOUTS ITSELF OVER AND AGAIN AS THE BEST IN THE WORLD IN EVERYTHING....KNOW THAT THEY ARE NO DOUBT BUYING THEIR RANKING FROM THE LIKES OF US NEWS AND WOLD REPORT!




HUMANA AND JOHNS HOPKINS TEAM UP WITH MANAGED-CARE NETWORK



BALTIMORE, Dec. 1 /PRNewswire/ --


Humana Inc., one of the nation's largest health maintenance organizations, and Johns Hopkins, one of the premier medical centers in the country, are teaming up to form physician networks throughout the state of Maryland.

Humana members also will be able to use Johns Hopkins hospitals and facilities in the state.

"This strategic affiliation is the first of its kind for Johns Hopkins," Health System President and CEO James A. Block, M.D., said. "We are tremendously pleased to be able to work with Humana, not least because of its experience nationwide in serving a managed-care population covered by Medicare."

The affiliation is between Johns Hopkins HealthCare LLC, led by John D. Stobo, M.D., which represents The Johns Hopkins Health System and The Johns Hopkins University School of Medicine, and Human Group Health Plan, Inc. of Washington, D.C., a wholly-owned subsidiary of Humana Inc.

Humana will use primary and specialty physician networks being formed by Johns Hopkins, such as the Wilmer Eye Network and networks in cardiology and pediatrics, and work with Johns Hopkins to develop a full complement of other networks in the state.

"This relationship with a medical center that has an international reputation for quality and innovation is terrific news for Humana and its members," said Humana Senior Vice President Phil Garmon, who also noted that Johns Hopkins Hospital has been rated best in the country for five consecutive years by "U.S. News & World Report" and more faculty physicians from its school of medicine than any other have been listed in the book, "Best Doctors in America." "It should be a mutually beneficial relationship for both parties. Humana obtains access to networks of quality physicians and high caliber medical facilities in Maryland and Johns Hopkins can utilize our many years of experience in managed care to develop and expand its networks."

Michael E. Johns, M.D., dean of the School of Medicine, added that, "As Humana's enrollment grows in central Maryland, this agreement will serve to heighten access to the faculty practice at Hopkins. This is another vote of confidence from a leading managed-care organization for the way in which we are responding to the changing health-care marketplace."

Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly-owned HMO companies with more than 3.8 million members in 22 states and the District of Columbia. Humana offers quality and affordable coordinated care in the form of HMOs, preferred provider organizations, point-of-service organizations, along with administrative-only services. In addition, Humana is one of the nation's largest providers of "HMO-style" health care to seniors through its federally approved Medicare products. -0- 12/1/95

____________________________________________
As I have said there are well-developed plans already developed for Expanded and Improved Medicare for All.  Any politician could run for Governor of Maryland and simply use existing policy and planning to implement.  Do not allow neo-liberals to tell you it can't be done because simply building oversight into Medicare health system will end 1/2 of expenditures just by ending fraud and profiteering!  This neo-liberals have wasted hundreds of billions of dollars developing this private system simply to make health care a global profit-maximizing industry and WE WILL TAKE IT BACK!!!!

National Physicians has a well-researched plan that will reverse this Wall Street takeover.  I want to acknowledge that while I believe these physicians are working for all of us....I do want to make sure that this is universal and equal and addresses massive health industry fraud and profiteering and is not only funded by more taxes on the public!  When I read that Vermont's will include Tort reform as a way to lower cost I know that the reasons Doctor's Malpractice insurance is so high is that the American Medical Association does not police or hold accountable the doctors repeatedly performing badly....it is just like these other white collar crimes that get hidden and moved around. 


TORT REFORM SHOULD NOT HAPPEN UNTIL THE AMA HAS PROVEN THAT IT IS POLICING THE MEDICAL PROFESSIONALS AND ARE TRANSPARENT TO THE PUBLIC!!!!!

Please take time to read the entire article below!


A National Health Program for the United States: A Physicians' Proposal
Reprinted from the New England Journal of Medicine 320:102-108 (January 12), 1989

Abstract:

Our health care system is failing. Tens of millions of people are uninsured, costs are skyrocketing, and the bureaucracy is expanding. Patchwork reforms succeed only in exchanging old problems for new ones. It is time for basic change in American medicine. We propose a national health program that would (1) fully cover everyone under a single, comprehensive public insurance program; (2) pay hospitals and nursing homes a total (global) annual amount to cover all operating expenses; (3) fund capital costs through separate appropriations; (4) pay for physicians' services and ambulatory services in any of three ways: through fee-for-service payments with a simplified fee schedule and mandatory acceptance of the national health program payment as the total payment for a service or procedure (assignment), through global budgets for hospitals and clinics employing salaried physicians, or on a per capital basis (capitation); (5) be funded, at least initially, from the same sources as at present, but with payments disbursed from a single pool; and (6) contain costs through savings on billing and bureaucracy, improved health planning, and the ability of the national health program, as the single payer for services to establish overall spending limits. Through this proposal, we hope to provide a pragmatic framework for public debate of fundamental health-policy reform. (N Engl J Med 1989; 320: 102-8.)


_____________________________________________

The problems with MD's health exchange are not isolated,......all of MD public policy is a disaster because none of it is written by public advocates.....it is entirely written by the corporate 1% that make policy simply to move profit to the top....ergo, people are not placed in charge because of talent but because of having the 3 monkey syndrome.....SEE NO EVIL, HEAR NOT EVIL, SPEAK NO EVIL....public policy in policing, education, development are all failures and hundreds of billions of the state's revenue have been lost just during O'Malley's tenure as Mayor of Baltimore and now Governor of Maryland.

Remember, the goal with these state health systems is to end Medicare and Medicaid as Federal programs and dismantle them through state policy!  We want to be shouting for Expanded and Improved Medicare for All!!

Also, please know it is not the democratic party bringing these republican policies forward.....it is neo-liberals that have control of the democratic party.  We simply need to rebuild the democratic party by running labor and justice to reverse all of this attack on public health!


Also note that it is Beilenson  leading with a so-called private non-profit EVERGREEN that is designed to catch all of what was public sector Medicare, Medicaid, and public sector health plans.....AND HE IS JOHNS HOPKINS.

Below is what is happening with all of Maryland policy----the connected are throwing together businesses to capture all the wealth from taxpayer money building something we do not even need as Medicare already has a system!


'Both had expanded rapidly to build the Maryland site, expecting it could give them a foothold in the potentially lucrative health-exchange market'.


Maryland officials were warned for a year of problems with online health-insurance site


By Aaron C. Davis and Mary Pat Flaherty, Published: January 11   Washington Post

More than a year before Maryland launched its health insurance exchange, senior state officials failed to heed warnings that no one was ultimately accountable for the $170 million project and that the state lacked a plausible plan for how it would be ready by Oct. 1.

Over the following months, as political leaders continued to proclaim that the state’s exchange would be a national model, the system went through three different project managers, the feuding between contractors hired to build the online exchange devolved into lawsuits, and key people quit, including a top information technology official because, as he would later say, the project “was a disaster waiting to happen.”

Timeline

A timeline of events and related documents tied to the Maryland health care exchange.


The Democratic gubernatorial hopeful is the only female candidate at the top of a ticket.


The repeated warnings culminated days before the launch, with one from contractors testing the Web site that said it was “extremely unstable” and another from an outside consultant that urged state officials not to let residents enroll in health plans because there was “no clear picture” of what would happen when the exchange would turn on.

Within moments of its launch at noon Oct. 1, the Web site crashed in a calamitous debut that was supposed to be a crowning moment for Maryland officials who had embraced President Obama’s Affordable Care Act and pledged to build a state-run exchange that would be unparalleled.

Instead, by the next morning only four people had signed up using the Web site — and amazed that anyone had gotten through the system successfully, state officials contacted each of them to make sure they were real. The site’s problems continue to prevent Marylanders from signing up for health insurance. As of Friday, 20,358 people had selected private plans, and state officials have said they do not expect to come close to their initial goal of 150,000 by the end of March.

This report is based on a Washington Post review of thousands of pages of previously undisclosed documents, including e-mails, internal reports, audits and court records, along with interviews with dozens of current and former contractors, state officials and others. The review shows that the creation of the exchange was dysfunctional from the start and that there were repeated missteps at almost every level.

On the morning of Oct. 1, shortly after Obama had proclaimed that Maryland would lead the charge in signing up residents for new health-care plans, the director of the state’s health exchange was repeatedly rejected by the network before she became the first to log on, with the help of her IT staff.

Since then, an unknown number of Marylanders have experienced the same frustration with the Web site and have been prevented from signing up for health insurance.

As the state continues to try to fix the site, Gov. Martin O’Malley (D) and state lawmakers are working to enact emergency legislation to spend millions to help insure those who could not sign up and had to begin the year with no coverage.

With many Marylanders still facing frozen computer screens and error codes when they attempt to select insurance, O’Malley is expected this coming week to decline an offer by the Obama administration to temporarily take over parts of the troubled site, despite the urging of some state Democrats to embrace the move. This past week, O’Malley acknowledged that the rollout “did not meet our expectations” but said that many things have been fixed and the state’s site is improving.

It’s a situation far different than what O’Malley predicted on a sunny morning in March 2010, less than 24 hours after Obama signed the Affordable Care Act. O’Malley called reporters to the entrance of an Anne Arundel County emergency room to announce that Maryland would begin drafting plans to “immediately begin the work to ensure our state leads the nation.”

‘There is a risk . . .’

Of the 14 states that opted to build and run their own health-insurance marketplaces, Maryland was among the earliest and most enthusiastic supporters of what became known as “Obamacare.” And it became the second state, trailing California, to enact legislation creating an exchange.

Lt. Gov. Anthony G. Brown (D), the highest-ranking elected official charged with implementing the law, was invited to speak across the country about the state’s early success. The Obama administration began depositing tens of millions of dollars in state accounts to pay for development, thinking Maryland’s exchange might be built so early that other states could copy it.

But out of public view, reports of trouble started arriving.

The first came in the fall of 2012, just over a year before the exchange was to launch. Auditors from the Portland, Maine-based firm of BerryDunn found that exchange officials were missing early deadlines to begin building the IT backbone for the public Web site, known as the Maryland Health Connection. The exchange was supposed to have signed agreements with state agencies that would allow them to link data from sources such as Medicaid and the Department of Motor Vehicles to the nascent site. But most agencies had not heard from the exchange or were unaware that the work was even overdue. The findings were summarized in a Nov. 1, 2012, letter to the president of the Maryland Senate and the speaker of the House of Delegates.

Almost $9 million in federal money was set aside to pay BerryDunn to be the watchdog for the high-profile project, with the expectation that Maryland officials would use the assessments to correct course as needed. The Post obtained copies of the confidential documents.

At the exchange’s temporary offices in north Baltimore during the fall of 2012, no one could produce for BerryDunn standard project plans showing a timeline and checklist for how the main IT contractor, from Fargo, N.D., would get the job done. The exchange’s staff, then just seven full-time state employees and borrowed ones from other agencies, “may not be sufficient to complete the work,” BerryDunn said in a PowerPoint presentation delivered to senior state officials in December. Five of the presentation’s slides began with: “There is a risk . . .”

One proved particularly prescient: Maryland might build all of the components of its health-insurance exchange and then put them together and find out they do not work, the presenters said. It was a serious risk, because the state also did not appear to be leaving itself with enough time to “complete, verify and test all system components before go-live.”

The 10 months that remained before the launch would go by quickly, the consultant warned, but corrective action could get the project back on track.

Two of O’Malley’s Cabinet members, his senior IT advisers and leaders of the exchange received copies of the confidential monthly reports, according to distribution lists. The first was also summarized in the technically worded letter to lawmakers. Aides to the legislative leaders said that the significance of the warning was not clear at the time and that they never knew the outside audits continued.

Late in 2012, the consultant’s reports focused increasingly on warnings that no one seemed to be in charge. Maryland Health Secretary Joshua Sharfstein; Human Resources Secretary Ted Dallas, the Cabinet member in charge of Medicaid; and Rebecca Pearce, the exchange leader, tried to make decisions together. It was a “three-headed-monster. . . . The next meeting could overrule the last. It was classic, you know, nothing was moving,” said one official who spoke on the condition of anonymity for fear of reprisal.

Within the exchange, Pearce, who had been lured away from a top job at Kaiser Permanente to run the system, was jostling with her own project manager for day-to-day control. Sunny Raheja was a state contractor who preceded Pearce on the exchange and would go to Sharfstein for decisions, according to documents as well as exchange officials who witnessed the dysfunction.

Ultimately, Raheja, who declined to comment, was replaced, and Pearce brought in a Medicaid IT specialist to run the technical side.

As Pearce’s new project manager began, the outside auditor said there was still no dis­cern­ible plan for building the exchange, no oversight by the state and poor communication among the contractors hired to build the online site.

“There is also no overall Master Project Plan and schedule that is being utilized to manage the milestones and activities necessary for the entire program effort,” BerryDunn warned in a Feb. 25 report.

The consultant broke the project into 11 categories and began labeling them as red, yellow or green — seven were in red, four were in yellow.

“From our perspective, agreement on a consolidated work plan will need input from all . . . so that there is a common understanding of what needs to occur between now and Oct. 1, 2013.”

In e-mails, Pearce’s new project manager said the situation appeared untenable. He resigned after a month, and the third project manager in three months took over in April — with six months to go before the site would launch.

“I think the wheels came off very early on,” said Amir Segev, who was deputy IT director for the exchange from February to May.

Segev said he left after only a few months “because it was a disaster waiting to happen.”

Contractors at odds

By May, the Obama administration was deciding which states would be allowed to proceed with building their own exchanges and which ones it would force to use the federal exchange. The team gave Maryland a deadline of June 1 to prove a core task: Its rudimentary software would have to communicate with a data hub the federal government was building to let states check whether health-care enrollees were eligible for subsidies.

The month of May became a sprint to make the deadline.

On one of the last days before the deadline, a federal team arrived at the Maryland IT contractor’s office in Linthicum, south of Baltimore, and sat in the front row of the briefing room with computers at each desk and a projection screen on the wall.

One part of the screen showed a fake enrollee’s information being sent from Maryland; the other showed the response from the federal hub. The two connected, and Maryland passed. Despite the internal turmoil and negative audits, the state seemed to finally be on the right path.

Sharfstein, the state health secretary, and Pearce called together the production team. Pearce put her foot on a chair and thanked everyone with a deep sense of relief evident in her voice.

News of the success also passed quickly to Brown and O’Malley, who began touting it in public appearances.

But as they celebrated, feuding between the two contractors in charge of doing much of the technical work to get the Web site running was getting worse.

Shortly after it had won Maryland’s initial $50 million contract, Noridian Healthcare Solutions, a company that grew out of Medicare claims processing, hired a Florida company — run by a former executive of Noridian’s parent firm — that renamed itself EngagePoint.

Noridian and EngagePoint agreed to share profits for development of the exchange, according to court documents filed by the companies — a move that state officials said they were made aware of only much later.

But within months of joining forces, the two were fighting over costs.

By July, according to court documents, infighting had brought work to a near-standstill.

Meanwhile, the software used successfully to pass the June test had to be replaced with newer and untested versions needed to meet federal security requirements.

In an interview, Sharfstein said the dispute had become a major distraction by then.

“For a while, we tried to play marriage counselor, but it was clear these were two companies that couldn’t work together well,” he said.

And another federal test was looming.

On Aug. 26, five weeks before the launch date, Maryland faced its final major test with federal overseers, a more thorough demonstration of how each part of its system would work.

This one did not go as well.

When the test got to the part of having a fictitious person choose a health plan, the Web site crashed. It also could not fully send enrollment data to insurers or e-mail Marylanders when they successfully selected a plan — something it still cannot do.

BerryDunn, the consultant, said the state must “hold Noridian to scheduled” deadlines and make 65 other changes. The state, it warned, also needed to start focusing on contingencies, knowing some parts of the site were bound to fail.

On a weekend in early September, Sharfstein logged on to measure the problems for himself. “You don’t want to know what he thought,” Pearce relayed in a message to her team, according to a testing report.

Pearce would soon send an e-mail titled “12 days out,” pleading with contractors to finish the job after she visited their Linthicum office on the evening of Sept. 18 and found it nearly empty.

“There’s a management methodology that has 4 aspects: pamper/pull/push/pummel. I think I have tried all of them at some point during this process,” she wrote at 11:24 p.m. “Tonight I am begging . . . we have got to make this reality.”

The success of the exchange was also becoming freighted with political implications as Brown launched his campaign for governor. In an early-morning e-mail on Sept. 23, Sharfstein wrote to Pearce, under a subject line “from today’s [Baltimore] Sun.”

He pasted in a line from U.S. Sen. Barbara Mikulski’s endorsement of the lieutenant governor the day before: “While we’re fighting to save Obamacare, we know that in Maryland we have a health exchange that’s ready to go because of Anthony Brown,” the Maryland Democrat said.

Pearce forwarded the e-mail to the heads of Noridian and EngagePoint, adding one line: “It’s time to get this right. Now. Period.”

Noridian chief executive Tom McGraw responded with military sparseness: “Understood.”

Testers filed their final report on Sept. 13, calling the last version of the software they could review “extremely unstable.” Internal testing of one aspect of the site found 449 defects, almost half of which would probably trouble the final release.

‘What’s wrong?’

On a conference call at the start of the final week of September, senior aides gave O’Malley a high-level summary of expected troubles with the exchange.

The Web site would not allow some people to check for subsidies or to select plans, but everyone should at least be able to log on, he was told, according to several aides.

The governor ended the call, said John Griffin, his chief of staff, saying the state should “move forward.”

But two days later, Griffin requested that a roomful of aides to the governor and Brown vote on whether to proceed. Most gave the Oct. 1 launch a green light. The next day, O’Malley smiled as Obama visited Prince George’s County and praised state leaders for being ready to roll.

Just after midnight on Oct. 1, programmers in the Linthicum office listened through a speaker phone to the anxiety growing in Pearce’s voice as she tried to log on, according to several people on the call. The site was not yet viewable publicly, but it should have allowed her to sign on. If there was one part of the site everyone agreed would work, it was this.

They waited for a second try and then a third as she reentered her name and address. Everything was correct. “What’s wrong?” she demanded.

No one was sure. Someone noticed that Pearce had left blank a box for the four-digit extension of her Zip code. Maybe the computer code required every single data field to be filled in to proceed. Try adding that, one manager said.

Pearce did not know the extension to her Zip code. They listened as she Googled it and attempted a fourth sign-on.

Click. She was in.

At 8 a.m., the exchange was supposed to launch simultaneously with other states, but it froze. The exchange posted a message online asking residents to come back in four hours.

Finally, at noon, officials watched from a command center in Baltimore as about 10,000 people logged on to the site, pinging servers in Fargo.

Screens showed blank graphs that should fill with enrollees moving through each phase of the system: creating accounts, checking for subsidies, shopping for plans, purchasing.

The stroke of noon came and went. No one logged on. No one bought health care.

The next morning was scarcely better. In the subject line of an e-mail to fellow contractors at 6:53 a.m., Noridian’s McGraw typed “Maryland is Down,” and wrote,“We cannot get through.”

More than 24 hours after the launch, there were just four people who had selected plans and eight more who appeared to have logged on.

An IT contractor wrote to state officials on Oct. 2 wondering if the four were “legitimate,” since contractors could not even access the site. She questioned if they might be fictitious accounts from prior phases of testing.

But later that day, the exchange’s chief information officer responded with good news: “The team has researched the 4 records and have determined these are for real customers. 3 applicants and 1 dependent. Applications have been processed albeit very slowly and sporadically.”

Pearce, who resigned under pressure in December, declined to comment on many aspects of the exchange’s development but said the wholesale failure on Oct. 1 “was a complete surprise to all of us.”

“We didn’t know it would be broken when we turned it on,” she said.

The day after the failed launch, Pearce sent an e-mail to the heads of Noridian and EngagePoint demanding answers.

“Gentlemen,” she wrote. “As the executives in charge of this program I would like to understand from you exactly what is happening with the project, and what you are doing to address our issues.”

But by the end of the first week of October, relations between the two companies were so strained that Pearce and Sharfstein acted as go-betweens. After more weeks of fighting, EngagePoint, the subcontractor, made a bold proposal to state officials, urging them to allow it to take over the project entirely. Days later, Noridian instead fired EngagePoint, whose programmers packed up their laptops and left, leaving some of the software in Ukraine, where EngagePoint had hired programmers.

It was now up to Noridian to fix the site — with few employees certain of where to begin. It began making offers to hire back fired EngagePoint workers it said were key to fixing the site.

EngagePoint chief executive Pradeep Goel was aghast. “We are not going to respond to ridiculous emails from Noridian demanding our team members show up for work after being escorted out of the office,” Goel wrote to McGraw and Noridian’s attorneys on Oct. 26. “Are you people on crack cocaine?”

EngagePoint persuaded a judge to sign a restraining order that blocked Noridian from hiring back workers to fix the site. Noridian countersued, and the state entered the fray, siding with Noridian for the sake of Marylanders who needed a functioning site.

Through its attorney, Daniel Graham, Noridian declined to discuss its work with EngagePoint, citing the ongoing litigation. In a statement, the company said that “the complexity of this project has led to a number of major issues beyond what was anticipated.” But the company believes that recent improvements have made the system easier to use and said it “will continue to work with the State” to improve it further.

Karen See, a spokeswoman for EngagePoint, said the firm would not discuss its work, also citing the lawsuits.

The full effect of the failed project on the two companies remains unclear. Both had expanded rapidly to build the Maryland site, expecting it could give them a foothold in the potentially lucrative health-exchange market.

Before the launch, the state had allocated about $100 million in federal money for the construction of its exchange, and, according to one estimate, it has spent tens of millions more since Oct. 1. It is unclear how much of the added costs federal officials will agree to cover. But the bigger question is how many people the state can sign up. 
IT'S THE MARYLAND APPROACH TO PUBLIC WORKS.....

Maryland’s next deadline is March 31, the date by which it expected 150,000 people to have used the site to select health insurance, excluding Medicaid. Officials have said the state will not meet that goal.

“It’s a problem for the people of Maryland, a problem for the people that Obamacare was supposed to help,” said Peter Beilenson, chief executive of the Evergreen Health Co-Op, a new Maryland insurer that launched its business on a bet that it could compete with the state’s bigger insurers on a smooth-running Maryland exchange.

The company had a waiting list of more than 1,000 people who were expected to sign up with it when the exchange turned on.

For months, however, it could barely sign up one. On its best day in recent weeks, its staff helped 10 people navigate Maryland’s site. Evergreen still has more than 1,000 people waiting to buy insurance.





Jennifer Jenkins, Jenna Johnson and Amy Goldstein contributed to this report.


0 Comments

January 13th, 2014

1/13/2014

0 Comments

 
The hype with the Affordable Care Act is that it moves to preventative care and it moves people from group living in senior centers to staying in their homes.  Sounds OK if you do not see how it actually works.  As I showed last time, Obama and the ACA is privatizing Medicare and Medicaid into these state health systems, something republicans have been trying to do for years and it is the neo-liberals doing it!  The idea is that to save Medicare for the upper middle-class you have to cull off the middle and working class to do it because after all 1/2 of Medicare spending has been stolen in health institution fraud and/or spent building the NSA spy network.

I wanted to focus on just a few issues in detail to show how detrimental the ACA is not only to all citizens but especially seniors.

THE ORGANIZATIONS SHOUTING OUT FOR ACA KNEW THESE ISSUES EXISTED BUT DELIBERATELY HID THEM FROM THE PEOPLE THEY PRETENDED TO SUPPORT!

So, seniors will stay in their homes as public retirement communities and public senior buildings close.  Don't worry they say, we are training tons of home health care people to come to your home to care for you.  OH, REALLY????

What is actually happening is that the ACA funding for this is not there.....kind of like NO CHILD LEFT BEHIND being an unfunded mandate.  So, all the public health support for seniors are being closed and handed to hedge funds to operate with no money coming to make sure quality care will occur.  WE ARE BEING GHETTOIZED.  Now, seniors were hard hit with fraud from this decade of massive corporate fraud-----savings, pensions, COLA increases eliminated for Social Security-----

A DELIBERATE ATTACK BY WALL STREET ON THE WEALTH GAINED BY BABY BOOMERS WITH OBAMA AND NEO-LIBERALS MAKING SURE WE CAN NOT GET JUSTICE!  ONLY, WHEN A GOVERNMENT SUSPENDS RULE OF LAW IT SUSPENDS STATUTES OF LIMITATION...

Seniors have been deliberately left without the retirement money they worked for and as we see below, the Medicare program that had strong support services for seniors are being dismantled as public health is handed to corporations for profit.  A senior in a senior care facility run by hedge funds as is the case in Baltimore with ManorCare?  Think Charles Dickens level of care for the elderly.  One imagines they will be forced to work with the disabled on menial labor to pay their way....which by the way seniors prepaid through payroll taxes.


ALL OF MEDICARE HAS BEEN PAID BECAUSE REAGAN TRIPLED PAYROLL TAXES IN THE 1980s JUST SO THERE WOULD BE PLENTY FOR BABY BOOMERS.  BUT DID THESE CORPORATIONS PAY THEIR SHARE OF THE PAYROLL TAX?  WE KNOW THAT PAYROLL FRAUD HAS BEEN RAMPANT.

We are not against immigrants coming to America to work and we are not against vocational tracking of students into health care.  What we are against is the outrageously inadequate level of training and knowledge people being sent to homes actually have.  This is serious.  People with chronic illness, people with psychological malady......these are serious and complicated health matters that these people being trained as home health workers have not a clue.  The people doing the job are not bad.....they are often not able to do the job or not trained right.  THAT DOES NOT MATTER....THE GOAL IS GETTING THE CHEAPEST MODEL IN PLACE TO MAXIMIZE PROFIT AND LOWER MEDICARE COSTS SINCE THERE IS NO MONEY IN THE TRUST.

Who is going to age into this mess?  Well, me no doubt as I am a regular middle-class professional with average means.  Remember, neo-liberals see the middle-class right now as give and take $200,000.  These are the wage earners that will be able to afford private senior care or the private insurance that allows it.  Right now that is less than 5% of US population.  It is the working/middle class that paid the most into these Trusts and it is these same people getting axed out of care with the ACA.

One thing you see throughout the Affordable Care Act is that there will be nurses and/or nurse practitioner involved in these health businesses taking over public health....including home health care.  As the commenter above pointed out in his review of one global corporation covering senior home health.....THERE WAS NOT A NURSE IN SIGHT.  HE HAD NO MEDICAL SUPERVISOR WITH WHOM TO TALK AND I HEAR THIS IN ALL CASES OF THESE HEALTH BUSINESSES.

You can see the same with education reform by privatization ------school boards filled with business people with no education background.  IT IS DELIBERATE AND IT WILL BREAK DOWN ALL PUBLIC HEALTH PROTECTIONS AND ALL STRUCTURES DESIGNED TO PROVIDE QUALITY CONTROL AND ACCOUNTABILITY.......which is the point of the ACA.....complete deregulation of the health care industry!





Social Security and Medicare taxes

Federal Insurance Contributions Act tax Federal social insurance taxes are imposed on employers[15] and employees,[16] ordinarily consisting of a tax of 6.2% of wages up to an annual wage maximum ($110,100 in 2012) for Social Security and a tax of 1.45% of all wages for Medicare.[17] For the years 2011 and 2012, the employee's contribution had been temporarily reduced to 4.2%, while the employer's portion remained at 6.2%,[18] but Congress allowed the rate to return to 6.2% for the individual in 2013. [19] To the extent an employee's portion of the 6.2% tax exceeded the maximum by reason of multiple employers, the employee is entitled to a refundable tax credit upon filing an income tax return for the year.[20]



You know what ACA does to Medicare access? It sends most care for seniors and Medicaid to home health care corporations....guess what? Cuts take even that access away!  Actually what Medicare is set to become for most will be the same as Medicaid......MEDICAID FOR ALL SAY THE AFFORDABLE CARE ACT PEOPLE! 

Below you see an industry political piece that tries to scare people into voting against democrats because this ACA policy will gut health care.   This article is truthful as to the effect cuts in funding will have on these private health businesses for home health but as someone that does not want these businesses getting all this Medicare funding.....I do not have sympathy for money lost to this industry.  As reformers cutting cost always say to the health industry-------figure out how to do it cheaper without losing your profits.  AND SO, THE LYING, CHEATING, AND STEALING BEGINS BECAUSE THEY ARE NOW REQUIRED TO FAKE THE NUMBER OF PATIENTS AND WHAT PROCEDURES THEY RECEIVE IN ORDER TO PAD PROFITS. 

Home Health Leaders: Unprecedented Medicare Cut Endangers Millions of Seniors' Access to Home Healthcare
November 25, 2013 2:22 PM PR NewsWire



Final Rule disregards input from lawmakers, seniors' advocates, and home health community –

CMS concedes that "approximately 40 percent of providers will have negative margins in CY 2017"(1)

WASHINGTON, Nov. 25, 2013 /PRNewswire-USNewswire/ -- Home health leaders warned that the Home Health Prospective Payment System (HHPPS) Final Rule, released Friday by the Obama Administration's Centers for Medicare and Medicaid Services (CMS), will directly impact the homebound seniors and disabled Americans who are the Medicare program's most vulnerable beneficiaries and will limit their access to the clinically advanced, cost effective home health care they need.

The HHPPS proposed rule initially included a 3.5 percent annual rebasing cut to Medicare home health funding – the maximum allowable under the Affordable Care Act (ACA) – which was calculated using an incorrect base year.  While the Final Rule now uses the correct base year (2010), it maintains the maximum annual rebasing cut of 3.5 percent, thereby imposing an unprecedented total rebasing cut of 14 percent over 4 years.

"From start to finish, this is a patient care issue," said Chairman Billy Tauzin, Senior Counsel to the Partnership. "The stated purpose of the Obamacare legislation was to expand Americans' access to healthcare, but this Obamacare regulation will do the exact opposite.  Despite pleas by lawmakers, seniors and stakeholders, CMS has decided to impose unprecedented cuts to the home health services on which the nation's most vulnerable Medicare population depends.  These cuts directly impact homebound seniors in rural, minority, and underserved communities who are among the Medicare program's oldest, sickest, and poorest beneficiaries."

"Despite the concerns expressed by more than 200 bipartisan Members of Congress, leading senior advocacy organizations, and dozens of other stakeholders, CMS chose to cut Medicare home health payments to the fullest extent allowed by the ACA," added Eric Berger, CEO of the Partnership.  "On a technical basis, this rule is also deeply flawed in that required analyses were never conducted on its impact over the full 4 years in which its cuts will go into effect or on the thousands of small businesses and their employees who will be impacted by it." 

"Just as troubling, the actual nature of this Final Rule has not been accurately disclosed," continued Mr. Berger.  "Although CMS releases seem to suggest that the Final Rule provides rebasing relief, the reality is that the cut in the Final Rule is the maximum allowable under the law.  The ACA authorized the Secretary to impose an annual rebasing cut of not more than 3.5 percent of the 2010 Medicare home health standardized payment rate.  The proposed rule exceeded the law in that it incorrectly applied the 3.5 percent cut to 2013 payment rates.  By contrast, the Final Rule applies the maximum allowable 3.5 percent annual cut to 2010.  As a result, all that can be said of the Final Rule is that, by properly replacing 2013 with 2010 as the base year, it no longer exceeds the law."


                               Base Year: 2013         Base Year: 2010

Proposed Rule       3.5%              EQUALS          4.5%

Final Rule                 2.7%              EQUALS           3.5%

"While there are so many people across the country whose health care will be adversely affected by this Final Rule, we are deeply thankful to the many lawmakers who devoted so much of their time and energy in an effort to protect Medicare home health beneficiaries," Mr. Berger added.  "They and the vulnerable Medicare beneficiaries they valiantly serve deserve better than this regulation."

Since the proposed rule was released, tens of thousands of patients, family members, providers, advocates, and state associations have cautioned the Administration that these cuts go too far and will have severe implications on the delivery of skilled home healthcare.  Extensive action was undertaken, including data and policy analyses, grassroots engagement, and extensive direct dialogue.  In addition, letters were filed by leading advocates including AARP, the American Hospital Association (AHA), the National Association of Home Care and Hospice (NAHC), the Visiting Nurses Association of America (VNAA) and many other stakeholders, all of whom expressed concern that the proposed cuts would negatively impact homebound seniors who depend on home health.

"The extraordinary cuts announced on Friday are alarming, especially in light of the deep cuts that Medicare home health has already suffered in recent years," added Senator John Breaux, Senior Counsel to the Partnership.  "Even before these latest cuts, funding for Medicare home health services had been reduced by more than $72 billion since 2009.  When factoring in these additional cuts, two of the nation's leading health care consulting firms – Avalere Health and Dobson|DaVanzo Associates – project that the home health delivery systems in nearly every State will experience net losses by 2017, which greatly jeopardizes seniors' access to high-quality, low-cost home healthcare.  In fact, even CMS concedes – on page 117 of the HHPPS Final Rule – that 'approximately 40 percent of providers will have negative margins in CY 2017' and that more than 8-in-10 of these providers are already experiencing negative margins as a result of pre-existing cuts!  For these reasons, we strongly urge decision makers to protect homebound seniors from this regulation and any further cuts in the weeks and months ahead."

"The fact that this extreme regulation is a result of Obamacare means it cannot help but have political in addition to access implications," concluded Chairman Tauzin.  "The Medicare cuts in the 2010 Obamacare bill angered seniors so much that voters over age 65 helped give Republicans control of the U.S. House in the President's first midterm elections.  These newest Medicare cuts, coming right out of Obamacare, could now put the Democrats' Senate majority in jeopardy when senior voters cast their ballots next November.  Both Democratic and Republican leaders tried to stop the White House from issuing this unprecedented cut, and both were ignored.  Three and a half million seniors depend on home health, they vote, and they are not likely to take these cuts lying down." 


With an estimated 10,000 American seniors entering the Medicare program every day, the Medicare home health benefit is widely recognized as a clinically advanced, cost-effective and patient preferred means for meeting the post-acute and long-term care needs of this rapidly growing patient population. Medicare home health services are delivered to approximately 3.5 million Medicare beneficiaries, who are documented as being more likely to be poor, old, sick, and minority than the Medicare beneficiary population as whole.  In light of its importance to millions of seniors and their families, the Medicare home health sector has been one of the nation's leading creators of new jobs according to the Bureau of Labor Statistics.


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As we see below a decade ago it was revealed that this growing industry was not functioning properly, had no oversight, and no public transparency.  Now, Baltimore and Maryland are 10 times worse than California in all these regards so one can imagine what this industry looks like in Maryland.  We have had our entire public sector health dismantled and handed to private non-profits run by health corporations.

As you see below this business system mirrors the lack of oversight, the fraud and corruption as all US business sectors only now it is public health.  I want to emphasize that because Maryland has no media reporting or investigation in all of this it is safe to conclude that what is happening here is happening in Maryland only more than likely worse.  Remember, Maryland has a waver from Medicare in oversight and that compounds the abuse.  See why Maryland has reduced Medicare spending?

------PEOPLE ARE DYING FROM NAKED CAPITALISM

I want to emphasize that these problems have not been addressed....they are worse!

Publicize Home Care Problems, Critics Say / Complaints about health providers hard to dig out

Janet Wells, Chronicle Staff Writer Published 4:00 am, Wednesday, May 24, 2000



In the wake of revelations about problems at Kaiser Oakland's home health program, consumer advocates are decrying the failure of state and federal agencies to inform the public about serious deficiencies among home health care providers.

The state Department of Health Services performs scores of investigations each year that reveal numerous problems. Yet the agency has no mechanism or requirement for public disclosure of its findings.

Such is the case even when violations are serious enough to put patients in "immediate jeopardy," as the state recently found was occurring at Kaiser.

"The fact is we have these problems, and there's no venue for reporting them," said Celi Adams, founder of Home Care Companions, a San Francisco-based group that trains people to provide home care for seriously ill relatives and friends.

"Nobody has the responsibility to put it out there, and it absolutely would be helpful to publish once a year what the complaints were, or the 10 worst home health agencies in the state."

Daniel Zingale, the interim head of the state's new Department of Managed Care, which will oversee health maintenance organizations starting July 1, agrees. He plans to issue a report on managed care with "easily accessible" information about state violations.

"There's definitely a need for more and better information being made available to the public," said Zingale, whose department is scheduled to take over much of the health care oversight responsibility of the Department of Corporations.

"Shining a spotlight on the strength and failings of managed care plans may be the best tool we have to ensure the quality of care they deliver," he said.

In Kaiser's case, the state investigation revealed problems so serious that they contributed to the death of one elderly patient from malnutrition, septic shock and deeply infected bed sores. Kaiser was given 23 days to fix the worst problems; it is now in compliance.

Although state reports on home health care providers are public record, it takes determination to dig one out.


The state performed almost 100 full surveys of the 944 home care providers last year, in addition to documenting investigations into 400 complaints.

A consumer seeking information about a particular home health agency must first determine which of the 13 state licensing and certification districts investigated it and then go to the district office in person to request the documentation.

But before the survey or complaint investigation is public record, the home health agency has up to several months to file a plan of correction and implement improvements.

After a brief follow-up visit by state evaluators to verify that changes are in place, the home health agency is left to monitor its own progress.

"It's all handled internally," Adams noted. "The public is not informed, and then it's a done deal. As a consumer, I want to know what's going on."


The idea is not to punish home health agencies, said Department of Health Services spokeswoman Lea Brooks. "You try to do everything you can to get the operator to comply."

Home health agencies have been sorely squeezed in recent years, facing severe staffing shortages, increased regulatory requirements and, since 1997, a 45 percent cut in reimbursement from Medicare, which pays for almost 80 percent of home health visits in California, according to state records.

Almost 300 agencies in California have closed in the last three years, mostly due to the deep cuts in Medicare reimbursement, said Connie Little, senior vice president of the California Association for Health Services at Home, an industry group representing 500 agencies.

Little pointed out that consumers have access to information on home health agencies from the Joint Commission on Accreditation of Healthcare Organizations, whose Web site is www.jcaho.org. The Illinois-based group has accredited 6,000 home health agencies nationwide, but participation in the accreditation survey process is voluntary and does not have the same focus -- or impact -- as a regulatory agency survey.

Little questioned whether consumers would benefit from public disclosure requirements in the home heath care industry. "If you're going for a regulatory fix, you get more regulations," she said. "I don't know if it increases the quality of care."


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Below you see a good description of what conditions have to be met before you can qualify for home health care.  Time and again I hear from people who need the service desperately they cannot qualify for Medicare help and the cost is prohibitive.  So, if the only option for seniors needing a support system to age into is home health and they have written the laws so that getting that help is not easily available what happens to seniors?

They fall prey to the worst of private companies that act as the 'safety net' that once were public run institutions.  Mind you, state run senior care has always been the pits......but being a public institutions there was the ability to hold the institution accountable for public interest.  In this reform, people will be tracked into these private care facilities given no oversight and transparency and making it hard for families to get justice for bad care.

THIS IS WHAT NAKED CAPITALISM AND HEALTH CARE LOOK LIKE AND IT WILL NOT BE PRETTY!



When the Medicare home health benefit pays for home health care

Section IV.g. Home Health Care Benefit (Part A and B)Question 1 of 10 (use "Last" or "Next" buttons to see more) Return to referring page

Medicare will help pay for your home care if all four of the following are true:

1. You are considered homebound. Medicare considers you homebound if you meet the following criteria:  

  • You need the help of another person or special equipment (walker, wheelchair, crutches, etc.) to leave your home or your doctor believes that leaving your home would be harmful to your health; and
  • It is difficult for you to leave your home and you typically cannot do so.
2. You need skilled care. This includes skilled nursing care on an intermittent basis. Intermittent means you need care little as once every 60 days to as much as once a day for three weeks (this period can be longer if you need more care but your need for more care must be predictable and finite). This can also mean you need skilled therapy services. Skilled therapy services can be physical, speech or occupational therapy;*

3. Your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care. The certification must also say that a plan of care has been made for you, and that a doctor regularly reviews it. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare. 

  • As part of the certification, doctors must also confirm that they (or certain other providers, such as nurse practitioners) have had a face-to-face meeting with you related to the main reason you need home care within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your doctor must specifically state that the face-to-face meeting confirmed that you are homebound and qualify for intermittent skilled care.
  • The face-to-face encounter can also be done through telehealth. In certain areas, Medicare will cover examinations done for you in specific places (doctors offices, hospitals, health clinics, skilled nursing facilities) through the use of telecommunications (such as video conferencing). 
4. You receive your care from a Medicare-certified home health agency (HHA).

*If you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. Even when your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you continue to need it.

If you have questions about billing issues for home health care you should contact 800-MEDICARE.

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A GLOBAL FRANCHISE CARING FOR OUR SENIORS.....HOW SPECIAL!!!!  Carlyle hedge fund has Baltimore's ManorCare!

A global leader in non-medical in-home senior care, the Home Instead Senior Care Network® has more than 900 international franchise businesses in operation, with key Home Instead Master Franchise markets still available worldwide.

Instead of worry, there's Home Instead®

The 85-and-older population is expected to more than triple between 2008 and 2050 in the United States alone. This staggering statistic not only proves the growing need for elderly home care, but also the fact that thousands of families are facing the same critical decision as you. You are absolutely not alone.

Since 1994, the Home Instead Senior Care® franchise network has been devoted to providing the highest-quality senior home care. Compassionate Home Instead CAREGiversSM are an invaluable resource in helping families eliminate worry, reduce stress and reestablish personal freedom. From Alzheimer's and dementia support to respite care and companionship, our more than 900 locally owned and operated offices are ready to help you through this difficult time.


Below you see a review written by a former employee.  Not surprising he recommends using smaller, local care as there is no consumer interest in this global corporate home health chain.  Sound familiar?  If you think this is bad for a cell phone business wait until it becomes life and death!

THAT'S THE WAY NEO-LIBERALS ROLL!!!

Exploiting health care workers and giving no attention to consumer communications----

Consumer Affairs
Consumer Complaints & Reviews


sally of St Paul, MN on Dec. 31, 2013

Satisfaction Rating1/5I worked at H. I. and also at another agency (where I am very happy). Home Instead doesn't pay well, but I really enjoyed my clients and have a much larger appreciation for seniors after working for them...I have reservations about them:

First, Home Instead doesn't have any nurses on staff just a million managers and supervisors who I have NEVER met who are constantly calling and emailing me. It's run very business-like not AT ALL personal. They are very micro managerial which is why I've wanted to leave and why I already have another job. They are over, over, overstaffed by people to over yet under manage the caregivers. When there is a problem, there is NO ONE to help- the "on call supervisor" is a joke- has never ever met the clients and is paid to basically answer the phone (I'm sure she calls in her hours on time which is probably why she's still there) but if you make a mistake 5 people you've never met to pound on you and tell you what you should have done...very corporate, over managed and under effective. Never met the owner.

The other company however, I have met the owner, nurses and the few staff. They are effective and staff manage themselves and know who to contact and know things will be handled promptly and effectively. The nurses actually are familiar with the clients, their meds, home, etc and are a phone call away. The small staff actually work TOGETHER cooperatively as an actual CARE TEAM (medical model) instead of destructively at each other (corporate model). I'd recommend a small independently run non-chain agency over an indifferent corporate business. As a CNA, almost-nurse and caregiver I feel for better care for your family go with a small, independent medically minded agency. It's better for both the client and caregiver. I also think that clients' family want a caregiver that is treated well.

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One thing you see throughout the Affordable Care Act is that there will be nurses and/or nurse practitioner involved in these health businesses taking over public health....including home health care.  As the commenter above pointed out in his review of one global corporation covering senior home health.....THERE WAS NOT A NURSE IN SIGHT.  HE HAD NO MEDICAL SUPERVISOR WITH WHOM TO TALK AND I HEAR THIS IN ALL CASES OF THESE HEALTH BUSINESSES.

You can see the same with education reform by privatization ------school boards filled with business people with no education background.  IT IS DELIBERATE AND IT WILL BREAK DOWN ALL PUBLIC HEALTH PROTECTIONS AND ALL STRUCTURES DESIGNED TO PROVIDE QUALITY CONTROL AND ACCOUNTABILITY.......which is the point of the ACA.....complete deregulation of the health care industry!


BELOW IS A REALLY, REALLY LONG REAL ACADEMIC STUDY THAT ADDRESSES THE NEED FOR NURSES IN SENIOR CARE CENTERS.  IT CLEARLY SHOWS THAT TAKING THESE NURSES OUT....ESPECIALLY COMPLETELY WILL BE HARMFUL.


Health Serv Res. 2004 April; 39(2): 225–250. doi:  10.1111/j.1475-6773.2004.00225.xPMCID: PMC1361005

Relationship of Nursing Home Staffing to Quality of Care

John F Schnelle, Sandra F Simmons, Charlene Harrington, Mary Cadogan, Emily Garcia, and Barbara M Bates-Jensen

To compare nursing homes (NHs) that report different staffing statistics on quality of care.

Data SourcesStaffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes.

Study DesignTwo groups of NHs (n=21) that reported significantly different and stable staffing data from all data sources were compared on quality of care measures.

Data CollectionDirect observation, resident and staff interview, and chart abstraction methods.

Principal FindingsStaff in the highest staffed homes (n=6), according to state cost reports, reported significantly lower resident care loads during onsite interviews across day and evening shifts (7.6 residents per nurse aide [NA]) compared to the remaining homes that reported between 9 to 10 residents per NA (n=15). The highest-staffed homes performed significantly better on 13 of 16 care processes implemented by NAs compared to lower-staffed homes.

ConclusionThe highest-staffed NHs reported significantly lower resident care loads on all staffing reports and provided better care than all other homes.

Keywords: Staffing, quality of careNursing home (NH) staffing resources necessary to provide care consistent with regulatory guidelines are the subject of national debate due to emerging evidence that existing staffing resources may not be adequate (U.S. Department of Health and Human Services 2000b). One recent study for the Centers for Medicare and Medicaid Services (CMS) reported that 4.1 mean total (nursing aides [NAs] plus licensed nurses) direct care hours per resident per day (hprd) and 1.3 licensed nurse hprd (.75 for registered nurses [RNs] and .55 for licensed vocational nurses [LVNs]) were the minimum staffing levels associated with a lower probability of poor resident outcomes, such as weight loss and pressure ulcers (Kramer and Fish 2001). This study is supported by other correlational data documenting a relationship between staffing (particularly RNs) and a variety of outcomes, including: lower death rates, higher rates of discharges to home, improved functional outcomes, fewer pressure ulcers, fewer urinary tract infections, lower urinary catheter use, and less antibiotic use (Linn, Gurel, and Linn 1977; Nyman 1988; Munroe 1990; Cherry 1991; Spector and Takada 1991; Aaronson, Zinn, and Rosko 1994; Bliesmer et al. 1998; Harrington et al. 2000; U.S. Department of Health and Human Services 2000b). Few studies have specifically examined the relationship between staffing and the implementation of daily care processes, but inadequate staffing has been associated with inadequate feeding assistance during meals, poor skin care, lower activity participation, and less toileting assistance (Spector and Takada 1991; Kayser-Jones 1996, 1997; Kayser-Jones and Schell 1997). The results of these correlational studies led two Institute of Medicine committees to recommend higher nurse staffing in nursing facilities, including 24-hour registered nursing care (Wunderlich, Sloan, and Davis 1996; Wunderlich and Kohler 2001;). An expert panel recommended even higher minimum staffing levels (4.55 hprd including 1.85 licensed nurse hprd) (Harrington et al. 2000). However, neither the correlational studies nor the CMS study directly measured specific care processes that may be better implemented in higher staffed homes and that could explain the effects on resident outcomes.

A second study conducted for CMS focused on this care process implementation issue (Schnelle, Simmons, and Cretin 2001). This study used staff time estimates in computerized simulations to predict the nursing assistant (NA) staffing ratios necessary to provide care recommended in regulatory guidelines. Care processes related to incontinence care, feeding assistance, exercise, and activities of daily living (ADL) independence enhancement (e.g., dressing), all of which are typically implemented by NAs, were included in the simulation. The results of this study showed that 2.8 to 3.2 NA hprd, depending on the acuity level of the NH population, were necessary to consistently provide all of these daily care processes. The NA staffing levels reported in this process-focused study are similar to those recommended by one expert consensus panel who also attempted to identify the labor requirements to implement key care processes, such as feeding assistance (Harrington, Kovner et al. 2000). Unfortunately, 92 percent of the nation's NHs report staffing levels below the staffing minimums identified by the expert panel as well as the two recent CMS studies, and more than 50 percent of NHs would have to double current staffing levels to meet these minimums (U.S. Department of Health and Human Services 2000a).

The fact that so many NHs report staffing levels below this minimum has led to recent efforts to develop staffing indicators so that long-term care consumers can make informed judgements about the adequacy of NH staffing within a facility. However, neither the simulated staffing predictions nor the expert consensus recommendations have been subjected to a field test evaluation. Based on the simulation predictions, one would hypothesize that higher staffed NHs would be better able to provide labor-intense daily care activities, such as feeding assistance, toileting assistance, repositioning, and exercise care. More specifically, it would be predicted that homes that report 2.8 to 3.2 NA hprd would perform significantly better than all other homes in the implementation of these daily care processes. The purpose of this study was to address this issue by describing the relationship between staffing levels in 21 NHs and directly measured processes of care that are both labor intense and recommended in NH regulatory guidelines. The primary question addressed in this study was: Is there a relationship between staffing, as separately reported by NH administrators and NAs, and the implementation of daily care processes that reflect quality of care?

Go to:MethodsSubjects and SettingRecruitment of homes was accomplished in two phases (Figure 1). In phase one, 175 homes were identified in the southern California region as being in the upper 75th percentile or lower 25th percentile according to staffing data reported by NH administrators in 1999 to the State of California (California Office of Statewide Health Planning and Development 2002). Mean total direct hprd was used to determine each home's percentile rank. Thirty homes agreed to participate (15 in each of the extreme quartiles). However, only 17 of the 30 homes remained in the same quartile according to state staffing data reported in the year 2000 (9 lower quartile; 8 upper quartile). In addition, six of the eight homes in the upper quartile in both years (stable homes) reported a decrease in staffing in 2000 (4.0 hours to 3.4 hours) with all six homes clustered at 3.4 direct care hprd. The two remaining homes in the upper quartile were more stable and reported 3.7 and 5.1 direct care hprd in 2000. Furthermore, NAs in these two higher staffed homes also reported significantly lower resident care loads on interview in the year 2001 when compared to homes in the remaining upper quartile, as will be reported later. Thus, homes were initially divided into the following three categories for analytical comparisons: nine homes that reported an average of 2.7 hprd in both 1999 and 2000 (Group 1: lower quartile homes), six homes that reported 3.4 hprd in both 1999 and 2000 (Group 2: upper quartile homes), and two homes that reported an average of 4.9 hprd in both 1999 and 2000 (Group 3: upper-decile homes).

Figure 1Flow of Participants through TrialBecause of the potential importance of the upper-decile homes, Phase 2 was initiated to recruit additional homes in the 91st to 100th percentile (upper decile) following the completion of data analyses for Phase 1 homes. Research staff was blind to the staffing percentile ranking for each home during the data collection and analyses for Phase 1 but not in Phase 2 (see Figure 1). In Phase 2, 47 homes in the Southern California region were identified as being in the upper decile according to 2000 state staffing data. These homes also had small (<10 percent) Medicare populations because large Medicare populations can inflate staffing levels for the long-term care portion of the NH. Four homes were recruited that reported staffing levels above 3.8 total hprd in the year 2000 (upper decile) for a predominantly long-term care population.

Thus, a total of 21 homes were studied across the two phases. Residents who were long stay (not covered by Medicare) were eligible for participation, and resident recruitment occurred over two weeks within each home. The number of participants and consent rates are illustrated in Figure 1. Onsite data collection both to assess quality of care and to confirm state staffing reports with NH staff interviews occurred over three consecutive days and were conducted from June 2001 to September 2002. State cost report staffing data were not available for the year 2001.

Staff Interviews: Accuracy of State Staffing Reports To check the accuracy of year 2000 staffing statistics reported by NH administrators to the state and also to update these statistics, research staff conducted interviews with 118 NAs who worked on the 7 a.m. to 3 p.m. and 3 p.m. to 11 p.m. shifts during onsite data collection in 2001–2002. The NAs were asked “How many residents are you responsible for today?” and “Are you working ‘short’?” Administrators were also asked to report the number of NAs, LVNs, and RNs that were usually scheduled during the time period that onsite data collection was being completed. These data were converted into staffing hours per resident day by assuming that a full-time staff member worked 7.5 hours and dividing staffing hours by the number of occupied beds in the facility. Even though these staffing data were not collected according to the same specific definitions used for the state reporting system, it does represent a more current staffing estimate. Independent checks of time cards to validate staffing statistics were not possible because it would have required consent from each NH staff member in the facility. The onsite staffing reports were not regarded as more or less accurate than the state staffing reports, only more timely. The agreement between the different staffing data sources was considered an important estimate of data accuracy.

Measurement DomainsSixteen care processes typically implemented by NAs were measured by research staff using standardized direct observation and resident interview protocols during three consecutive 12-hour weekdays in each NH. The care process measures relevant to NA job performance can be divided into four major domains: out of bed/social engagement; feeding assistance; incontinence care; exercise and repositioning. Each of these NA care process measures can be defended as representing “good practice” and should be sensitive to differential NA staffing between homes because most of these care processes are also labor intense to implement.

All participants were observed with at least one of three different observational protocols (described below), but subgroups of participants were selected for interview. Participants with an MDS recall score of two or greater were asked questions about the occurrence of specific care processes (e.g., How often do you receive walking or toileting assistance?) because a recent study showed that residents who meet this interview selection criterion are able to accurately describe the care they receive (Simmons and Schnelle 2001). However, all participants were asked more general questions about the quality of assistance (e.g., Do you have to wait too long?) because there is evidence that residents who are capable of completing an interview can provide stable responses to these types of questions. Eleven care process measures related primarily to licensed nurse staff performance (e.g., pressure ulcer risk assessment) were evaluated based primarily on medical record review, with the exception of two resident interview measures, using standardized protocols.

Out of Bed and Engagement: Observations To assess participants' time spent in bed and social engagement during the day research staff observed participants for one 12-hour day (7 a.m. to 7 p.m.). The time-sampling protocol involved locating each participant every hour between 7 a.m. and 7 p.m. and observing the resident for up to one minute. Engagement was defined as interaction with either a staff member, a resident, or another person; an organized group activity; or with an object (e.g., television, reading, sewing). These two measures (out-of-bed time and engagement) are related to staffing levels, because assisting residents out of bed is labor intense since it occurs during the morning or evening periods when there are numerous competing activities (e.g., breakfast) and the resident must be dressed or groomed at the same time. There is evidence that NH residents spend excessive times in bed (Schnelle et al. 1998). It was also hypothesized that staff in high-staffed homes would have more time either to interact with or encourage residents to participate in activities during the day. Social interaction with and prompting residents to participate in activities are not necessarily labor intensive but are optional care activities that may not occur if staff are rushed to provide more mandatory physical care (e.g., providing feeding assistance to residents).

Feeding Assistance: Observation and Interview Measures Seven measures related to the quality of feeding assistance care were measured using direct, continuous (not time-sampled) observations during meals in which one staff member observed six to eight participants. All feeding assistance measures were assessed regardless of dining location (dining room versus room), with the exception of social interaction and verbal prompting during meals. The percent of social interaction or verbal prompts during meals was designed to assess the quality of feeding assistance, and interaction was counted if at least one minute of social interaction or verbal prompting occurred between the resident and the NH staff. Social interaction during meals has been related to increased food intake, and even the most cognitively impaired resident should receive some verbal prompts and social interaction during meals as opposed to physical assistance rendered in silence. The development, rationale, and scoring rules for all feeding assistance care process measures have been described elsewhere (Simmons et al. 2002). Brief descriptions of a few measures are provided here. Two measures were related to determining if a resident who is at risk for weight loss due to either low oral food and fluid intake or physical dependency on staff for eating, received at least a minimal amount of staff assistance during meals. Participants were considered to “pass” the first care process measure if they ate less than 50 percent of their meal but still received more than one minute of staff assistance. The logic of this indicator is that residents with intake below 50 percent are at risk for weight loss, and staff should try to provide assistance to these residents. If a resident ate less than 50 percent and received less than one minute of staff attention, it is not possible to separate poor assistance from other explanations for the poor eating. Participants were considered to pass the second care process measure if they were rated as physically dependent on the MDS and received more than five minutes of assistance. A measure relating to the accuracy of NH staff documentation of residents' oral food and fluid intake during meals and, thus, the ability of staff to identify residents with potentially problematic intake was also assessed. A participant passed this care process measure if he or she was observed by research staff to eat less than 50 percent of their meal and NH staff recorded less than 60 percent. Low intake is associated with weight loss and accurately identifying this problem is a logical prerequisite for prevention. Participants who had an MDS recall score of two or greater were also asked one interview question related to the NH food service, “If you don't like the food served at a particular meal, can you get something else?”

It was hypothesized that feeding assistance would be significantly associated with staffing levels because it is labor intense to provide this daily care process for all residents who need it. Both the simulation predictions conducted for the CMS study and one expert consensus panel predicted that a NA staffing ratio of two to five residents per NA is necessary to provide adequate feeding assistance care (Harrington, Kovner et al. 2000; Schnelle, Simmons, and Cretin 2001).

Incontinence Care: Interview Measures Incontinent participants, according to the most recent MDS assessment, with MDS recall scores of two or greater were asked how often they received toileting assistance, and all incontinent residents who responded to the interview questions were asked the more general question, “Do you have to wait too long for assistance?”

Exercise and Repositioning: Observation and Interview Measures Observational data relevant to participants' physical movements were obtained from a wireless monitor worn on the thigh that measures horizontal and vertical orientation every four seconds. Preliminary research showed that repositioning movements in bed were characterized by the monitor recording a minimum 40° move in the horizontal position followed by maintenance of at least a 20° change in the horizontal position and at least two 40° vertical changes when repositioning occurred in a chair. The monitor also enabled the detection of physical activities that involved sustained participant movement for at least six minutes and, thus, could possibly reflect an episode of exercise care. Because exercise (e.g., walking assistance) could not be discriminated from care processes that involved movement for other reasons (e.g., incontinence care), all participant movements that were sustained for at least six minutes were characterized as “activity episodes” possibly related to exercise. The thigh monitor was used because preliminary data indicated that any observational schedule feasible for a human observer to implement with more than three residents would underestimate the frequency of care episodes, such as walking and repositioning, that occur less than every two hours and are relatively brief in duration.

Two movement measures were calculated from thigh monitor data. First, the number of repositioning episodes per hour was calculated for participants who were noted in the medical record as being on a two-hour repositioning program and who could not reposition themselves independently according to a performance test conducted by research staff. In this test, participants who were unable to move from side to side unless they received physical assistance were considered dependent on staff for repositioning. Next, the number of activity episodes per hour was calculated for each of the above participants to determine whether there were differences between high- and low-staffed homes in the provision of care processes that could be interpreted as exercise.

Finally, all participants with MDS recall scores of two or greater and who were in need of walking assistance were asked how many walking assists they received per day. The participants' need for walking assistance was determined during a performance test conducted by research staff in which participants were asked to stand and walk and provided graduated levels of assistance to do so. Participants who were unable to stand and bear weight, even if provided full physical assistance by research staff, were excluded from this analysis. It was hypothesized that higher-staffed homes would be more likely to consistently provide exercise, repositioning, and walking assistance to participants because all of these care processes are labor intensive.

Medical Record Review: Licensed Nurse Measures Descriptive information for all participants was collected from the medical record and the most recent MDS or the annual assessment for some items. A trained physician or geriatric nurse practitioner conducted medical record reviews to assess care processes related to licensed nurse activities. It was hypothesized that licensed nurses in homes with higher staffing would perform better at assessment of conditions typically managed by nurses, as opposed to primary care providers, than licensed nurses in homes with lower staffing.

Eight of the licensed nurse care process measures used in this study are derived from the RAND Assessing the Care of Vulnerable Elderly (ACOVE) project. The quality indicators in the ACOVE project were operationalized with specific scoring rules and data sources identified for rating each indicator. The methodology used to develop the ACOVE indicators and the evidence that supports their validity has been reported elsewhere (Wenger and Shekelle 2001; Shekelle et al. 2001; Saliba and Schnelle 2002). Eight care processes from the set of ACOVE quality indicators most relevant to licensed nurse performance were identified by a geriatric nurse practitioner and clinical nurse specialist who covered three care areas: pressure ulcer, incontinence assessment, and pain. In addition, three care processes that were not specific ACOVE indicators were identified that evaluated how well nurses either assessed pain or provided medications to residents with chronic pain.

The ACOVE indicators are relatively self-explanatory even though it should be noted that liberal scoring rules were used to determine if a participant's medical record documentation met the pass criteria for each indicator. For example, in regard to incontinence Indicator 5, a medical record was considered to have fulfilled the intent of this indicator if documentation was provided for just two of the three conditions (e.g., skin health, genital system examination, fecal impaction assessment). The measures used to assess how well nurses were detecting and treating pain requires more explanation.

Three interview measures were used to evaluate licensed nurse performance relevant to pain. Research staff attempted to interview all participants with MDS recall scores of two or above with a set of six questions about pain. Two questions were related to communication between the licensed nurse and the resident regarding pain, “Do you tell the nurse about your pain?” and “Does the nurse ask you about pain?” We report data on the latter question and hypothesized that licensed nurses in higher-staffed homes would ask participants about pain more frequently than nurses in lower-staffed homes. Directly taking a proactive approach and asking residents about pain was considered better care than the more passive approach of simply reacting when a resident spontaneously complains of pain.

The four remaining pain questions were used to identify participants with chronic pain symptoms. Participants were asked: “Do you have pain every day?”; “Does pain ever keep you from doing things you enjoy (like social activities, walking)?”; “Does pain ever keep you from sleeping at night?”; and “Do you have pain right now?” Participants were judged as endorsing chronic pain if they responded “yes” to the question, “Do you have pain everyday?” or if they responded “yes” to all three remaining pain questions. To assess how well licensed nurses were detecting pain we determined the percent of participants who were judged as having chronic pain according to research staff interview who also had licensed nurse documentation of pain on the most recent MDS assessment. We also assessed licensed nurse performance relevant to management of chronic pain. First, we identified a subgroup of participants who had chronic pain according to research staff interviews. Then we determined the percent of this subgroup of participants who were offered pain medication by the licensed nurse at least 50 percent of the days in the previous month. We believed that licensed nurses in higher staffed homes would both detect chronic pain symptoms and offer as needed pain medication more frequently than licensed nurses in lower staffed homes.

Reliability and Stability Interrater reliability for time in bed and engagement observational measures was statistically significant for both measures but high only for the in-bed measures (measures 1 and 2, Table 3; kappa values .65 and .29; p<.001). A subset of 272 participants was observed for a second day on these measures to evaluate stability. The Pearson correlation was .79 for in-bed and .47 for engagement (p<.05). Interrater reliability for all observational-based feeding assistance care process measures shown in Table 3 (measures 3 to 10) ranged from .92 to 1.0; n=55 to 199; p<.001. Mealtime observations were repeated on a second day for all participants and correlations between the two days were significant on all variables (range .22 to .75; p<.05) with social interaction and verbal prompting measures showing the lowest but still significant correlations. The low correlation for this social interaction variable was due to the relatively low frequency that this behavior was observed. Correlations for all the other nutritional measures were above .60. Correlation between a resident's reported having received toileting assistance on two separate days (measure 11, Table 3) was .62; p<.01. The interrater agreement for the interpretation of thigh monitor data necessary to calculate exercise care process measures (measures 13, 14, 15) produced kappa statistics of .61 for repositioning movements, .82 for activity episodes while in a chair, and .75 for activity episodes while in bed. The correlation of a participant's report of walking assistance (measure 16) between two days was calculated for 38 residents (day 1 number of assists reported versus day 2 number of assists reported; r=.35, p<.05).

Table 3Observation and Interview Measurement DomainsGo to:ResultsCharacteristics of Participants in Key Comparison GroupsTable 1 shows the demographic characteristics of the participants in each group of homes. There were significant differences between participants in all three groups (Table 1). In particular, participants in the upper-decile homes were significantly more likely to be female, older, private pay, and Caucasian when compared to participants in all the other homes; while participants in the lower quartile homes were significantly more likely to be minority and MediCal. In terms of participant acuity, participants in the lower quartile homes (Group 1) tended to be more independent for transfer and feeding assistance and had better cognitive functioning (MDS recall scores) when compared to participants in both the 75th to 90th percentile (Group 2) and upper-decile homes (Group 3). There was no difference on five MDS based acuity measures (recall, transfer and eating dependency, incontinence, pressure ulcer RAP triggered) when comparisons were made between residents in the highest-staffed homes (upper decile) and those in the two lower-staffed homes (combined Groups 1 and 2 versus Group 3).

Table 1Facility and Demographic Characteristics of Participants in Sample Nursing HomesTo address generalizability issues, efforts were made to determine if differences existed between 9 highest-staffed and 45 lower-staffed homes that declined participation in this project and the 6 highest-staffed and 15 lower-staffed homes that participated. The homes that declined participation and the homes that participated were compared on MDS-derived measures of prevalence of weight loss, physical restraint use, and residents' need for assistance with transfer, eating, and toileting characteristics, all of which are available from a new public reporting system in California (http://www.calnhs.org). In addition, data were available describing homes' profit status, total nursing staff hours, nursing staff turnover, total federal deficiencies cited for 2001–2002, and expenditures for direct resident care per resident day. The only difference between participating lower-staffed homes and nonparticipating lower-staffed homes was on the expenditures per resident per day ($59 versus $68, respectively; t=2.115, p=.04). The only difference between participating and nonparticipating highest-staffed homes was on for-profit status of the home (33 percent versus 100 percent, χ2=8.182, p=.004). These results should be cautiously interpreted but in general suggest that the homes participating in this project comprise a relatively typical sample.

Sample Characteristics: Staffing DataTable 2 illustrates the staffing data for the three groups of NHs. The first eight rows alternatively illustrate state staffing statistics for the year 2000 and onsite staffing data reported by administrators. There were large differences between high-decile homes and all remaining homes on all staffing variables except RN hours according to 2000 state staffing data. These differences are most dramatic for total staffing hours and aide staffing hours. In regard to total hours, high decile homes reported an average of 4.88 hours compared to lower quartile and 75th to 90th percentile homes that reported 2.7 and 3.4 hrpd, respectively. There were also significant but less dramatic differences between homes in the lower quartile and the 75th to 90th percentile on most staffing variables. However, interview data collected in 2001–2002 while the research team was onsite suggested that there were no longer differences between lower quartile homes and those in the 75th to 90th percentile on any staffing variable. Lower-quartile home administrators reported an increase in total staffing from 2.7 in 2000 to 3.2 in 2001–2002 and the 75th to 90th percentile homes reported a staffing decrease from 3.4 to 3.0. Administrator reports of staffing and NA reports of workload continued to show a significant difference for Group 3 (upper decile) homes compared to the remaining homes. Administrators reported a total of 4.5 hrpd in 2001–2002 in the upper-decile homes. Both administrators and NAs in the upper-decile homes reported a ratio of residents to NAs on the 7 a.m. to 3 p.m. and 3 p.m. to 11 p.m. shifts combined that were very close (7.1 to 7.6 residents to NAs, respectively). These reports were significantly different from the NA workload reports in other homes (e.g., nine to 10 residents per aide, see Table 2, rows 9, 10). These data suggest that there are two distinct groups of homes based on staffing statistics. The difference in staffing between Group 1 and Group 2 homes is not only small and unstable, but also well below those minimums thought to indicate better care according to both expert panels and recent CMS studies. Alternatively, the homes in the upper decile were not only dramatically higher on staffing measures when compared to all other homes but also staffed at those levels thought to be necessary to provide good care (Harrington, Kovner et al. 2000; Schnelle, Simmons, Cretin 2001; Kramer and Fish 2001). For these reasons, the primary comparisons on all care process measures were conducted between homes in the upper decile (Group 3) and the remaining sample (Groups 1+2 combined).

Table 2Staffing Characteristics of Sample Nursing HomesNA Care Process Measures: Do Homes That Report the Highest NA Staffing (Group 3 Upper Decile) Provide Different Care Than the Remainder of the Homes (Groups 1 and 2 Combined)Table 3 illustrates that upper-decile homes (Group 3) were significantly different in the same direction on 13 of 16 different care process measures; and, in eight cases significance levels exceeded p<.001. The probability that 13 out of 16 comparisons would be significant at the .05 level by chance is less than .00001. The pattern of significant differences was consistent across all care areas listed in Table 1, but the care process differences were most compelling for feeding assistance and least compelling for exercise and repositioning. In general, participants in the upper-decile homes spent more time out of bed during the day; were engaged more frequently; received better feeding and toileting assistance; were repositioned more frequently; and showed more physical movement patterns during the day that could reflect exercise. However, even participants in these highest-staffed facilities did not receive repositioning at the rate of once every two hours during the day or night and only received potential exercise activities at the rate of approximately one episode every four hours. In addition, there were no differences between the groups of homes in repositioning frequency at night; walking assistance frequency during the day as reported by the participants; or the amount of social interaction observed between residents and staff during meals.

Social interaction during meals could only be measured in the dining room, and participants in the upper-decile homes were observed significantly more often in the dining room than those in the remaining homes. If one assumes that there are very low or zero levels of social interaction between residents and staff if residents eat in their rooms, which is a reasonable assumption, then there would be significant overall differences in the amount of social interaction that participants in upper-decile homes received during meals as compared to participants in all remaining homes.

There were no differences on five MDS-based acuity measures that could explain why more residents ate in their rooms more often in the lower-staffed homes (Groups 1 and 2 combined versus those in the highest-staffed NHs—see Table 1). The significant higher age of residents in the highest-staffed home would seem predictive of these residents spending more time in bed as opposed to less time as was observed. However, none of the demographic characteristics including age were correlated with in-bed or feeding assistance measures across all homes. A multiple regression analysis using staffing as a categorical variable (upper decile versus all others) and MDS acuity scores that were correlated with in-bed time (transfer and feeding assistance, recall scores, and prevalence of UI and pressure ulcer RAP triggered) revealed that staffing remained the only significant predictor of in-bed time (standardized beta=−.28, standard error=8.8, p<.003).

Licensed Nurse Performance MeasuresTable 4 presents the licensed nurse comparisons between the three groups of homes. Unlike the NA care process comparisons, there were no licensed nurse performance measures that favored the upper-decile homes. In fact, licensed nurses in the lower-staffed homes performed better on 2 of the 11 indicators when compared to the upper-decile homes (Group 3). This difference was primarily due to Group 1 homes' nurses scoring significantly better on two pressure ulcer indicators. In addition to the low pass rates for higher-staffed homes on licensed nurse measures, there was also relatively poor performance on some indicators across all homes. Specifically, no group of homes performed well on the indicators assessing licensed nurse management of chronic pain by offering “as needed” pain medication on at least 50 percent of the days in the prior month to those residents with chronic pain symptoms. Less than 10 percent of participants who had chronic pain symptoms and who also had a physician's order for pain medication “as needed” were offered the pain medication on at least 50 percent of the days in the prior month across all homes. Furthermore, licensed nurses failed to identify many residents with chronic pain because less than 50 percent of participants who had chronic pain also had documentation of pain on their most recent MDS assessment. The kappa statistic agreement for residents with chronic pain on two different interviews was .65 (p<.01), indicating high stability. Finally, licensed nurses in all homes also performed poorly on several of the incontinence indicators. Most notably, no incontinent participants had documentation of a three-to-five day toileting assistance trial, which is the most valid method of determining if a resident should receive a scheduled toileting program.

Table 4Measures of Licensed Nurse Care ProcessesGo to:DiscussionNursing home self-reported staffing statistics do reflect differences in quality between homes that report the highest staffing level (upper decile) and all remaining homes. There were few differences between homes that report staffing levels below the 90th percentile and the staffing levels in these homes were unstable across the different staffing measures. There appears to be a two-tiered staffing system with only the homes reporting the highest level of staffing showing both stability and significantly better care on most measures.

The most dramatic differences between the homes were reported for NA hours and the most dramatic quality improvement occurred for homes that reported a total staffing hrpd average from 4.8 (state data) to 4.5 (onsite interview data). There was also a significant improvement in these upper-decile homes for multiple care processes delivered by NAs even though residents in the upper-decile homes needed as much care according to multiple functional measures as residents in the lower-staffed homes.

There were smaller differences between homes in reported licensed nurse hours and particularly RN hours and there were also fewer differences between homes on licensed nurse performance measures. The differences that did exist favored the lower-staffed homes for two pressure ulcer assessment indicators derived from medical record data. In contrast, observation and resident interview measures related to pressure ulcer care actually received by residents (e.g., toileting assistance, repositioning care) favored the upper-decile homes. This finding highlights an important discrepancy between quality conclusions about NH care process implementation derived from different data sources (medical record versus observation and resident interview).

Despite this discrepancy, it is still surprising that the medical record documentation provided by licensed nurses in higher-staffed facilities was not better since other studies have reported a relationship between licensed nurses' hours and some quality measures (Kramer and Fish 2001). There are two potential explanations for this finding. First, it is possible that none of the homes in this study had adequate licensed nurses, particularly RNs, to improve care quality. Furthermore, RN hours failed to reach the minimum level recommended by a recent CMS study (.75 hours) in all homes, and RN hours were much less in all homes than that recommended by an expert panel (1.15 hours) (Harrington, Kovner et al. 2000). Second, licensed nurses in all facilities simply may be unaware of some care processes that define good quality (e.g., no homes documented a trial of toileting assistance for incontinent residents and all homes did poorly on all pain-related measures). This possibility reinforces arguments that licensed nurses who practice in NHs should receive more specialized training focused on the NH population.

It is also important to note that some care processes were poorly implemented in even the highest-staffed facilities, despite the fact that these facilities had sufficient numbers of NAs to potentially provide 100 percent of care to all residents. One plausible explanation for this finding is that all homes lacked management mechanisms necessary to assure that care was provided on a daily basis, in particular, for care processes that are difficult to measure and manage. For example, the fewest differences occurred between homes on care processes related to repositioning and walking exercise, both of which are difficult to measure when compared to more visible types of care (e.g., resident out of bed). In addition, even though the highest-staffed facilities provided better feeding assistance than other homes, there were still problems that could be traced to measurement issues. For example, even staff in the highest-staffed facilities did not accurately record that 48 percent of the residents were eating less than 50 percent of the food offered and that 54 percent of these low-intake residents were provided less than one minute of feeding assistance during meals. Both of these problems in higher-staffed homes could reflect the absence of a quality assessment technology to accurately measure and monitor these care processes.

We should also note that the differences in the care for the highest-staffing homes (Group 3, upper decile) and all lower-staffed homes were significantly greater than the differences in quality measured for homes that differed on MDS clinical quality indicators. This finding, as reported in other studies, suggests that staffing data may be the best information to give consumers (Bates-Jensen et al. 2003; Simmons et al. 2003; Schnelle, Cadogan et al. 2003; Cadogan et al. 2003; Schnelle et al. 2004).

The conclusions are limited to the relatively small regional sample and our inability to check staffing accuracy with time card records even though time card accuracy checks can also be problematic (Hurd, White, and Feuerberg 2001). Fortunately, the reports by aides of their workloads appears to be a measure that is both associated with other workload reports and discriminative of care quality. This fact suggests that consumers might want to monitor the adequacy of staffing in NHs by asking aides how many people they are working with.

It is also possible that NH characteristics correlated with staffing may have mediated some of the effects reported in this study. For example, higher wages and benefits and lower staff turnover have been linked to better quality and we did not measure these variables. Future studies should expand the number of NH homes (particularly high-staffed homes) and variables studied in an effort to more comprehensively delineate the effects of staffing on quality. The low number of high-staffed homes in this study prevented statistical controls for potentially important facility variables that differentiated these homes, such as size and proportion of Medicaid residents. In addition, we did not measure all resident acuity variables that may have explained why residents in low-staffed homes spent so much time in bed. Direct measures of a resident's sickness severity are particularly important for this purpose.

The standardized measurement technology described in this paper represents a major strength of this study. The measurement protocols are clearly defined, can be replicated, and meet scientific measurement criteria related to reliability and stability. Even though one can argue about the importance of some of the measures for assessing quality, the specificity of the measures allows for this argument to be evidence-based.

Despite the limitations of this study, an excellent case can be made that the highest-staffed homes provided better care. Furthermore, NA staffing levels reported by only the highest-staffed homes exceeded those levels that were identified in two recent CMS reports as associated with higher care quality. This finding provides some verification that NA staffing above 2.8 hours per resident per day is associated with better quality.

Go to:FootnotesSupported by a grant from the California HealthCare Foundation. The views expressed in this paper are those of the authors and may not reflect those of the Foundation. The California HealthCare Foundation, based in Oakland, California, is a nonprofit philanthropic organization whose mission is to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of the people of California. This research was also supported by grant AG10415 from the National Institute on Aging, UCLA Claude D. Pepper Older Americans Independence Center.






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January 10th, 2014

1/10/2014

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AS NEO-LIBERAL ECONOMISTS LIKE REICH AND KRUGMAN SHOUT OUT AGAINST THE WEALTH INEQUITY OF TODAY WITHOUT EVER ACKNOWLEDGING THAT IT ISN'T INEQUITY-----IT WAS A VISIGOTH LOOTING OF THE AMERICAN SOCIETY BY MASSIVE CORPORATE FRAUD------WE SAY, A GOVERNMENT THAT SUSPENDS RULE OF LAW SUSPENDS STATUTES OF LIMITATION!

I see in Baltimore all these middle-class homeowners that were able to keep their homes in hard times and I am shouting----financial analysts are warning to get rid of houses as this coming economic crash will bring a depression so you may be next!  Gentrification will go up the income scale!



I spoke last time about how Obama and neo-liberals played this entire crisis like a playbook written by Wall Street.  We saw how these main street bailouts were deliberately written so that only the affluent homeowners would access help and the FHA, a vital agency with a long service to families was targeted to be shut out.  Neo-liberals are working just as hard as republicans to end all War on Poverty and New Deal programs and fair housing goes!!!!  So, the middle-class  holding on to jobs and their homes now had better buckle-up because financial analysts are calling for people owning homes to get rid of them as the next, more powerful economic collapse comes soon......

THIS IS OBAMA'S LEGACY AND ALL OF MARYLAND'S DEMOCRATS ARE NEO-LIBERALS AND ALL EQUALLY RESPONSIBLE. 


SHAME AND DISGRACE FOR MARYLAND NEO-LIBERALS WATCHING SILENTLY AS THIS UNFOLDED.

What could we do, they say?  When 50 states attorney general shout out in 2005 that the mortgage industry is systemically criminal--------

YOU SHOUT OUT TO MARYLAND CITIZENS NOT TO GET INVOLVED IN THESE LOANS.  THEN, YOU SHOUT OUT OVER AND OVER THAT JUSTICE HAS NOT OCCURRED!

That is what a democrat would do!


Below you see the housing program that Obama and neo-liberals pretended was the bailout of main street and help in curbing foreclosures.  It was a ruse of course as they fumbled the roll-out long enough for most people that could have gotten help went under trying to get it!  Mind you....some people were helped.  The percentage I see over and again is 10% of foreclosures were saved.

 I sit and watch the same banks and mortgage corporations that created the massive subprime mortgage fraud now connected with HARP, earning more money from fees attached to yet another mortgage refinance.  From Quickens Loans to  Wells Fargo and Bank of America.....they are earning billions on HARP.

HARP Program Requirements In order to participate in HARP you need to meet the following requirements:

  • Your mortgage must be owned or guaranteed by Fannie Mae or Freddie Mac
  • You must be current on your mortgage, and cannot have made a payment more than 30 days late in the past year.
  • You must have negative home equity (you owe more on your mortgage than your home is worth), but your mortgage cannot exceed 125% of the value of your home.
  • Refinancing must help the affordability or stability of your mortgage.
  • You must have the ability to continue making payments
  • Mortgage owned or guaranteed by the FHA, VA, or USDA are not eligible for HARP.
  • Your property must be 1-4 units.
  • Your property must also be your primary residence. 2nd homes are not eligible for refinancing under HARP.
________________________________________________
As you see, HARP deliberately excludes FHA and the other government mortgages from this 'stimulus' and these loans are for those needing the help the most.  See why tens of millions of people went into foreclosure?  They were the ones most affected by the massive frauds and simple Rule of Law would have kept those homes with those families.

The reason Obama and neo-liberals in Congress chose Freddie and Fannie for this stimulus is that these loans were private mortgages and they wanted bank mortgages to be stabilized with the higher end prices and they are trying to end FHA and low-income homeownership. Neo-liberals work with republicans to end all War on Poverty and New Deal programs!

Obama and neo-liberals called these homeowners 'responsible' because they were able to weather years of recession.


Remember, they wanted everyone out of property ownership and into rentals because Pottersville landlords can keep people poor with high rents and control where they live!  Neo-liberals are socially engineering this return to Medieval society with the serfs outside the castle gates....into what is suburbia.  What about equal housing and access?  THE BILL OF RIGHTS GOES WITH TPP YOU KNOW!  In Maryland, the ACLU is actually helping with this even as it is unconstitutional.


The FHA was a successful program for decades causing very little cost for taxpayers.  So, the only reason to get rid of it is that it took away profit for banks wanting the mortgage business. 





Fannie Mae and Freddie Mac purchase mortgages from financial institutions, providing a way for those financial institutions to have more cash to continue to lend money for additional mortgages. Congress enacted a statutory mission for these GSEs to bring "liquidity, stability and affordability to the U.S. housing and mortgage markets."


FHA mortgages were created by the United States government to give borrowers with low credit scores and down payments who could not qualify for a Freddie Mac mortgage the opportunity to buy a home.


_____________________________________________


When Obama chose to suspend Rule of Law and allow all this mortgage fraud go without justice it was the old, women, and children who were hit the hardest.  Seniors taking home equity loans thinking they would be able to address them over time did not know massive corporate fraud was being allowed to go unabated.  These were the 'irresponsible' homeowners Obama and neo-liberals allowed to be taken under.

Now, Wall Street wanted all real estate back into the hands of the banks so if you watch TV you are familiar with the REVERSE MORTGAGE DEALS THAT HAND HOMES TO THE BANKS AFTER SENIORS DIE.  This is handy for families with seniors struggling to survive, but it was yet another device to move homeownership away from average people as these families who would normally have inherited these homes now had no inheritance.  Meanwhile, the estate taxes are being eliminated slowly but surely for the wealthy.


THE FIRST THING A DEMOCRATIC SOCIETY DOES IS PROTECT THE OLD AND YOUNG....NOT NEO-LIBERALS!

THIS WAS MASSIVE FRAUD AND THE ECONOMY WAS DAMAGED BY THIS FRAUD.  ALL OF THE AID BY CONGRESS SHOULD HAVE COME TO MAIN STREET.  RULE OF LAW DEMANDS IT SO------WHEN GOVERNMENT SUSPENDS RULE OF LAW THEY SUSPEND STATUTES OF LIMITATIONS!

Senior Citizens Worst Hit By Foreclosures in America
Filed Under Repo Homes

It is the senior citizens that have been worst hit by the foreclosure crisis in America. About 28% of those boiling in the foreclosure cauldron are aged above 50. A recent study by AARP has questioned the validity of the hitherto popular surmise that the seniors have escaped the crisis because of they had built up sufficient equity on their houses.

The research done by AARP show that 684,000 persons aged 50 are in foreclosure during the last six months of 2007. Those who were above 50 comprised of 28% of all those who were in the foreclosure soup. Of these 684,000 senior borrowers, 50,000 were in foreclosures and lost their houses.

At the close of 2007 the rate among senior citizens of America who were in foreclosure was 0.24%. This was half of those who were aged less than 50 and have less equity than their elders.

Susan Reinhard of Public Policy Institute said that the seniors of America are dependent on their houses both as a shelter and an asset when retirement knocks. She said, “Losing a home jeopardizes long-term financial security with limited time to recover.”

The report also highlights the effects of the sub-prime mortgage crisis on those who were aged 50 and above. This group was 17 times more likely to be caught by foreclosure than those with prime mortgages. The states with high repo home rates among the seniors are California, Nevada, Colorado and Michigan.

Older Americans had made use of the equity on their houses for making repairs to their property and financing the higher education of their children. But seniors with fixed income are facing problems making mortgage payments. The sluggish economy with inflation is making the going even tougher for those with advancing age. Fall in the real estate market has affected all age groups.

Daniel Alpert of Westwood Capital that both young and old who had siphoned off the equity on their houses are now rocking on the same boat of foreclosure Many seniors like the juniors contracted teaser loans thanks to the aggressive peddling of the same by agents. The mortgage forms were also difficult to comprehend. The call of the hour is simplified mortgages. So it was a question of sales talk and trust that were misused for disastrous consequences for all – the lender, the borrower and the community together with the hapless individual whether young or old.




______________________________________________



Below you see an article from Fall 2011 talking about how very few on main street were able to access HARP from the time it rolled out with the bank bailout.  This was supposedly main street's bailout but between the long-term unemployment creating the environment of missed payments and the banks constantly 'losing paperwork' that basically caused most people applying to fail to be considered. 

ALL OF THIS WAS DELIBERATE AS THIS ENTIRE MORTGAGE FRAUD WAS ABOUT GETTING MAIN STREET OUT OF THEIR HOMES SO THE GOAL WAS TO GET AS MANY HOMEOWNERS AS POSSIBLE INTO FORECLOSURE. 

Here in Maryland advocates for people heading to foreclosure shouted even into 2012 that  the money intended to augment people heading to foreclosure from the $25 billion mortgage fraud settlement was not getting to people.  So, just think, people who we all know were struggling from the economic downturn were left from 2009-2012 mostly unable to get the help they needed with this HARP policy. 

Flash forward to 2013 and we see Obama shouting that those funds set aside for HARP be used.  By now, most people of average means have lost their homes to foreclosure.


The Home Affordable Refinance Program (HARP): What you need to know

By Hayley Tsukayama, Published: October 24, 2011

On Monday, the federal government announced that it would revise the Home Affordable Refinance Program (HARP), implementing changes that The Washington Post’s Zachary A. Goldfarb reported would “allow many more struggling borrowers to refinance their mortgages at today’s ultra-low rates, reducing monthly payments for some homeowners and potentially providing a modest boost to the economy.”

The HARP program, which was rolled out in 2009, is designed to help. Those who are “underwater” on their homes and owe more than the homes are worth. So far, The Post reported, it has reached less than one-tenth of the 5 million borrowers it was designed to help. Here’s a quick breakdown of what you need to know about the changes.

Video

Oct. 24 (Bloomberg) -- Edward J. DeMarco, acting director of the Federal Housing Finance Agency, talks about the regulator's mortgage relief program that will expand to allow homeowners to refinance regardless of how much their houses have dropped in value.

Gallery

  Flashback: Last year, some mortgage lenders and government officials took action after discovering that many mortgage documents were mishandled.


What was announced? The enhancements will allow some homeowners who are not currently eligible to refinance to do so under HARP. The changes cut fees for borrowers who want to refinance into short-term mortgages and some other borrowers. They also eliminate a cap that prevented “underwater” borrowers who owe more than 125 percent of what their property is worth from accessing the program.

Am I eligible? To be eligible, you must have a mortgage owned or guaranteed by Fannie Mae or Freddie Mac, sold to those agencies on or before May 31, 2009. The current loan-to-value ratio on the mortgage must be greater than 80 percent. Having a mortgage that was previously refinanced under the program disqualifies you from the program. Borrowers cannot not have missed any mortgage payments in the past six months and cannot have had more than one missed payment in the past 12 months.

How do I take advantage of HARP? According to the Federal Housing Finance Agency, the first step borrowers should take is to see whether their mortgages are owned by Fannie Mae or Freddie Mac. If so, borrowers should contact lenders that offer HARP refinances.

When do the changes go into effect? The FHFA is expected to publish final changes in November. According to a fact sheet on the program, the timing will vary by lender.



____________________________________________

I speak quite often about the targeted families in urban centers because of what is happening in Baltimore.  The black middle-class was hit hardest as their wealth was often tied to these urban areas hit with mortgage fraud and as we know the US Justice Department has failed to give any justice to people of color in these urban centers.  City Hall is not only allowing the subprime loan fraud go without justice......I have spoken about how City Hall is actually preying on these citizens with home seizures from faulty utility bills or small amounts of back taxes.

THIS IS NOT A DONE DEAL AS ALL OF THIS HAS YET TO SEE JUSTICE AND RULE OF LAW WILL HAVE LOW-INCOME HOUSING FOR VICTIMS OF FRAUD IN THE CITY CENTER!


The Great Eviction: Black America and the Toll of the Foreclosure Crisis From predatory loans to evictions at gunpoint, neighborhoods are hosting bitter conflicts between activists and market forces—By Laura Gottesdiener

| Thu Aug. 1, 2013 1:04 PM


We cautiously ascend the staircase, the pitch black of the boarded-up house pierced only by my companion's tiny circle of light. At the top of the landing, the flashlight beam dances in a corner as Quafin, who offered only her first name, points out the furnace. She is giddy; this house—unlike most of the other bank-owned buildings on the block—isn't completely uninhabitable.

It had been vacated, sealed, and winterized in June 2010, according to a notice on the wall posted by BAC Field Services Corporation, a division of Bank of America. It warned: "entry by unauthorized persons is strictly prohibited." But Bank of America has clearly forgotten about the house and its requirement to provide the "maintenance and security" that would ensure the property could soon be reoccupied. The basement door is ajar, the plumbing has been torn out of the walls, and the carpet is stained with water. The last family to live here bought the home for $175,000 in 2002; eight years later, the bank claimed an improbable $286,100 in past-due balances and repossessed it.

It's May 2012 and we're in Woodlawn, a largely African American neighborhood on the South Side of Chicago. The crew Quafin is a part of dubbed themselves the HIT Squad, short for Housing Identification and Target. Their goal is to map blighted, bank-owned homes with overdue property taxes and neighbors angry enough about the destruction of their neighborhood to consider supporting a plan to repossess on the repossessors.

"Anything I can do," one woman tells the group after being briefed on its plan to rehab bank-owned homes and move in families without houses. She points across the street to a sagging, boarded-up place adorned with a worn banner—"Grandma's House Child Care: Register Now!"—and a disconnected number. There are 20 banked-owned homes like it in a five-block radius. Records showed that at least five of them were years past due on their property taxes.

Where exterior walls once were, some houses sport charred holes from fires lit by people trying to stay warm. In 2011, two Chicago firefighters died trying to extinguish such a fire at a vacant foreclosed building. Now, houses across the South Side are pockmarked with red Xs, indicating places the fire department believes to be structurally unsound. In other states--Wisconsin, Minnesota, and New York, to name recent examples—foreclosed houses have taken to exploding after bank contractors forgot to turn off the gas.

Most of the occupied homes in the neighborhood we're visiting display small signs: "Don't shoot," they read in lettering superimposed on a child's face, "I want to grow up." On the bank-owned houses, such signs have been replaced by heavy-duty steel window guards. ("We work with all types of servicers, receivers, property management, and bank asset managers, enabling you to quickly and easily secure your building so you can move on," boasts Door and Window Guard Systems, a leading company in the burgeoning "building security industry.")

The dangerous houses are the ones left unsecured, littered with trash and empty Cobra vodka bottles. We approach one that reeks of rancid tuna fish and attempt to push open the basement door, held closed only by a flimsy wire. The next-door neighbor, returning home, asks: "Did you know they killed someone in that backyard just this morning?"

The Equivalent of the Population of Michigan Foreclosed
Since 2007, the foreclosure crisis has displaced at least 10 million people from more than four million homes across the country. Families have been evicted from colonials and bungalows, A-frames and two-family brownstones, trailers and ranches, apartment buildings and the prefabricated cookie-cutters that sprang up after World War II. The displaced are young and old, rich and poor, and of every race, ethnicity, and religion. They add up to approximately the entire population of Michigan.

However, African American neighborhoods were targeted more aggressively than others for the sort of predatory loans that led to mass evictions after the economic meltdown of 2007-2008. At the height of the rapacious lending boom, nearly 50% of all loans given to African American families were deemed "subprime." The New York Times described these contracts as "a financial time-bomb."

Over the last year and a half, I traveled through many of these neighborhoods, reporting on the grassroots movements of resistance to foreclosure and displacement that have been springing up in the wake of the explosion. These community efforts have proven creative, inspiring, and often effective—but in too many cities and towns, the landscape that forms the backdrop to such a movement of hope is one of almost overwhelming destruction. Lots filled with "Cheap Bank-Owned!" trailers line highways. Cities hire contractors dubbed "Blackwater Bailiffs" to keep pace with the dizzying eviction rate.

In recent years, the foreclosure crisis has been turning many African American communities into conflict zones, torn between a market hell-bent on commodifying life itself and communities organizing to protect their neighborhoods. The more I ventured into such areas, the more I came to realize that the clash of values going on isn't just theoretical or metaphorical.

"Internal displacement causes conflict," explained J.R. Fleming, the chairman of the Chicago Anti-Eviction Campaign. "And there's no other country in the world that would force so much internal displacement and pretend that it's something else."

Evictions at Gunpoint
It was three in the morning when at least a dozen police cruisers pulled up to the single-story, green-shuttered house in the African American Atlanta suburb where Christine Frazer and her family lived. The precise number of sheriffs and deputies who arrived is disputed; the local radio station reported 25, while Frazer recalled seeing between 40 and 50.

A locksmith drilled off the home's locks and dozens of officers burst into the house with flashlights and handguns.

"Who's in the house?" they shouted. Aside from Frazer, a widow with a vocal devotion to the Man Above, there were three other residents: her 85-year-old mother, her adult daughter, and her four-year-old grandson. Things began to happen fast. Animal control rounded up the pets. Officers told the women to get dressed. Could she take a shower? Frazer asked. Imagine there's a fire in your house, the officer replied.

"They came to my home like I was a drug dealer," she told reporters later. Over the next seven hours, the officers hauled out the entire contents of her home and cordoned off the street to prevent friends from helping her retrieve her things.

"I have no idea where some of my jewelry is, stuff I bought when I was 30 years old," said Frazer. "I am sixty-three. They just threw everything everywhere, helter-skelter on the front lawn in the dark."

The eviction-turned-raid sparked controversy across Atlanta when it occurred in the spring of 2012, in part because Frazer had a motion pending in federal court that should have stayed the eviction, and in part because she was an active participant of Occupy Homes Atlanta. But this type of militarized reaction is often the outcome when communities—especially those of color—organize to resist eviction.

When Nicole Shelton attempted to move back into her repossessed home in a picket-fence subdivision in North Carolina, the Raleigh police department sent in more than a dozen police officers and an eight-person SWAT team. Officers were equipped with M5 submachine guns. A helicopter roared overhead. In Boston, one organizer with the community group City Life/Vida Urbana remembers the police acting so aggressively at an eviction blockade in a Haitian neighborhood that the grandmother of the family had a heart attack right in the driveway.

And sometimes it doesn't require resistance at all. On the South Side of Chicago, explained Toussaint Losier, a community organizer completing his Ph.D. at the University of Chicago, "They bust in the door, and it's at the point of a gun that you get evicted."

Exiles in America
There have been widespread foreclosures—and some organized resistance—in predominately white communities, too. Kevin Kirkman, captain of the civil division of the Lee County sheriff's office, explained, "I get so many [eviction] papers in here, it's unbelievable."

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More than 75% of the residents in North Carolina's Lee County are whites. But Kirkman still sees the ripple effects of mass foreclosure here. "You're talking about a mudslide where a lot of things are affected. You're talking about taxes, about retail sales if people move, about food services, about gasoline. You see what I'm talking about? When you lose a family in the community? Some people leave the community. I have seen people leave the state of North Carolina."

He added, "I'm going be honest with you, my feeling is that I would not do these evictions."


______________________________________________
I wanted to end with this main stream shout out that the subprime mortgage loan fraud is recognized by all and the amount of these frauds are in the trillions of dollars and as of now we have gotten maybe a trillion in subprime loan settlement and most of that has been sent right back to banks as developers......WE ALL KNOW THIS!

Op-Ed Columnist The Mortgage Fraud Fraud

By JOE NOCERA Published: June 1, 2012 

I got an e-mail the other day from Richard Engle telling me that his son Charlie would be getting out of prison this month. I was happy to hear it.

Charlie’s ordeal isn’t over yet, of course. When he leaves prison on June 20, Charlie, 49, will move temporarily to a halfway house, after which he will be on probation for another five years. And unless he can get the verdict overturned, he will have to spend the rest of his life with a felony on his record.

Perhaps you remember Charlie Engle. I wrote about him not long after he entered a minimum-security facility in Beaver, W.Va., 16 months ago. He’s the poor guy who went to jail for lying on a liar loan during the housing bubble.

There were two things about Charlie’s prosecution that really bothered me. First, he’d clearly been targeted by an agent of the Internal Revenue Service who seemed offended that Charlie was an ultramarathoner without a steady day job. The I.R.S. conducted “Dumpster dives” into his garbage and put a wire on a female undercover agent hoping to find some dirt on him. Unable to unearth any wrongdoing on his tax returns, the I.R.S. discovered he had taken out several subprime mortgages that didn’t require income verification. His income on one of them was wildly inflated. They don’t call them liar loans for nothing.

Charlie has always insisted that he never filled out the loan document — his mortgage broker did it, and he was actually a victim of mortgage fraud. (The broker later pleaded guilty to another mortgage fraud.) Indeed, according to a recent court filing by Charlie’s lawyer, the government failed to turn over exculpatory evidence that could have helped Charlie prove his innocence. For whatever inexplicable reason, prosecutors really wanted to nail Charlie Engle. And they did.

Second, though, it seemed incredible to me that with all the fraud that took place during the housing bubble, the Justice Department was focusing not on the banks that had issued the fraudulent loans, but rather on those who had taken out the loans, which invariably went sour when housing prices fell.

As I would later learn, Charlie Engle was no aberration. The current meme — argued most recently by Charles Ferguson, in his new book “Predator Nation” — is that not a single top executive at any of the firms that nearly brought down the financial system has spent so much as a day in jail. And that is true enough.

But what is also true, and which is every bit as corrosive to our belief in the rule of law, is that the Justice Department has instead taken after the smallest of small fry — and then trumpeted those prosecutions as proof of how tough it is on mortgage fraud. It is a shameful way for the government to act.

“These people thought they were pursuing the American dream,” says Mark Pennington, a lawyer in Des Moines who regularly defends home buyers being prosecuted by the local United States attorney. “Right here in Des Moines,” he said, “there was a big subprime outfit, Wells Fargo Financial. No one there has been prosecuted. They are only going after people who lost their homes after the bubble burst. It’s a scandal.”

The Justice Department has had a tough run recently. Last week, Eric Schneiderman, the New York attorney general — who was recently given a role by President Obama to investigate the mortgage-backed securities issued during the bubble — complained publicly that he wasn’t getting the resources he needed from the Justice Department. And, of course, on Thursday, a federal judge declared a mistrial on five charges of campaign finance fraud and conspiracy in the trial of the former presidential candidate John Edwards.

In the Edwards case, the Justice Department spent tens of millions of dollars, and trotted out novel legal theories, to prosecute a man who was essentially trying to keep people from discovering that he had had a mistress and an out-of-wedlock child. Salacious though it was, the case has zero public import. Yet this same Justice Department isn’t willing to use similar resources — and perhaps even trot out some novel legal theories — to go after the pervasive corporate wrongdoing that gave us the financial crisis and the Great Recession. (I should note that the Justice Department claims that it “will not hesitate” to prosecute any “institution where there is evidence of a crime.”)

Think back to the last time the federal government went after corporate crooks. It was after the Internet bubble. Jeffrey Skilling and Kenneth Lay of Enron were prosecuted and found guilty. Bernard Ebbers, the former chief executive of WorldCom, went to jail. Dennis Kozlowski of Tyco was prosecuted and given a lengthy prison sentence. Now recall which Justice Department prosecuted those men.

Amazing, isn’t it? George W. Bush has turned out to be tougher on corporate crooks than Barack Obama.






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January 08th, 2014

1/8/2014

0 Comments

 
AS WITH THE AFFORDABLE CARE ACT AND RACE TO THE TOP......THESE NEW MORTGAGE RULES SUPPOSEDLY 'CONSUMER' FRIENDLY ARE ACTUALLY CREATING BOUNDARIES FOR HOME-OWNERSHIP FOR THE PEOPLE THE FHA WAS MEANT TO SERVE.  ALSO, LOOK AT WHY SOME RULES, LIKE JUMBO LOANS, CAME AND WENT.  IT WAS ALL ORCHESTRATED AROUND THOSE TRILLIONS IN PROFIT FROM FRAUD AND REFINANCING OVER AND OVER AND OVER.  TAXPAYERS PAID MUCH OF THAT REFINANCING WITH $700,000 LOAN LIMITS!



About Housing

The Office of Housing provides vital public services through its nationally administered programs. It oversees the Federal Housing Administration (FHA), the largest mortgage insurer in the world, as well as regulates housing industry business.

Legislation in the 1960s expressed the social concerns of providing decent and sanitary housing and ensuring that such housing is made available to all. In that sprit, Executive Order 11063, Equal Opportunity in Housing, was issued in 1962 and represented the first major effort by the federal government to combine civil rights with housing. Title VI of the Civil Rights Act of 1964 assured nondiscrimination on federally assisted programs. Equality in housing opportunity was legislated by Title VII of the Civil Rights Act of 1968, the Fair Housing Act, which prohibited discrimination in the sale, financing, or leading of housing. The full protection of the law was expanded by the Fair Housing Amendments of 1988, further prohibiting discrimination based on familial status or handicap.

In 1965, the Housing and Urban Development Act created HUD to succeed the HHFA as a cabinet-level agency.

The 1960s brought a new method of developing low-income housing. The Housing and Urban Development Act of 1965 initiated a new leased housing program to make privately owned housing available to low-income families. The Housing and Community Development Act of 1974 (1974 Act) replaced Section 23 with the Section 8 Leased Housing Assistance Payment Program (Section 8). Title I of the 1974 Act created a new community development block grant (CDBG) program.



The Present

The mission of HUD, to “promote adequate and affordable housing, economic opportunity, and a suitable living environment free from discrimination” continues to focus the department’s initiatives.




'The new rules will help protect consumers and reduce the risk that the economy will crash again because of shoddy lending, Senator Elizabeth Warren, a Democrat of Massachussetts, said yesterday'.

Let's take a look at the new rules from Elizabeth Warren's Consumer Financial Protection Bureau (CFPB) regarding mortgages handled by federally insured Fannie and Freddie.  Now, keep in mind that neo-liberals and neo-cons are working to dismantle these two agencies and end the Federal government's involvement in the mortgage industry.  That was one of the goals of imploding these agencies with fraud after all!  So, new rules for mortgages by the CFPB seem to come just as they will no longer be needed.  This is why the article shows how Wells Fargo.....a leader in private mortgage business and SUBPRIME MORTGAGE LOAN FRAUD EXTRAORDINAIRE......is building a structure for handling loans outside these new rules by the CFPB.  Keep in mind that Warren is being sold as a darling of the progressives when in fact she is a global corporate and free market supporter.....none of that is progressive.

IT IS A HOAX TO KEEP THE CURRENT FHA FROM DOING THE JOB OF SECURING LOANS FOR LOW-INCOME PEOPLE WHILE TRANSITIONING/CLOSING THIS PUBLIC AGENCY.


Remember, the Federal Housing Agency was started to provide low-cost housing loans to low-income people and worked successfully for the few decades it was independent.  No drama, no improper and fraudulent loan activity....simply a well-run Federal agency that helped people become homeowners.  THIS IS A GOOD THING WE WANT TO KEEP.  It was when it was made into a public private partnership as Freddie and Fannie that it became profit-driven and fraudulent and this was the plan.....to blow up a strong public sector service and send it back to Wall Street.  This is what these mortgage reforms are all about!  This is not consumer friendly.....it protects the banks.

Wells Fargo Creates Swat Team to Keep Loans In-House: Mortgages

By Dakin Campbell and John Gittelsohn Jan 8, 2014 8:08 AM ET

  Wells Fargo Wells Fargo & Co. (WFC), the largest U.S. home lender, has assigned about 400 underwriters to originate mortgages for the bank to hold, with as many as 40 percent of the loans likely to fall outside government guidelines taking effect this week.

The bank is training the group as a way to increase lending without losing control of quality, according to Brad Blackwell, head of portfolio lending for the San Francisco-based lender. The group will review loans including those with terms that prevent them from qualifying for protections provided by the Consumer Financial Protection Bureau, or CFPB, under new rules, he said.

Wells Fargo, responsible for about one in five U.S. mortgages last year, is pushing the initiative to compete for clients seeking non-conventional loans such as those with interest-only payments. That segment will be increasingly sought-after at a time when rising interest rates are curbing borrowing demand and banks are facing the biggest regulatory overhaul since the Great Depression.

“As rates continue to rise and refinancing volume continues to contract, lenders are going to be looking for a way to keep their staffs busy,” said Erin Lantz, director of mortgages at Zillow Inc.

Congress directed the CFPB, formed as part of the 2010 Dodd-Frank Act, to create the qualified mortgage rule after banks were blamed for helping spark the 2008 credit crisis by giving mortgages to people who couldn’t afford them. The regulations provide a measure of legal protection to banks that meet guidelines and expose them to legal liabilities if the loans charge high fees or require total debt payments exceeding 43 percent of the borrower’s income.

‘Sweeping Re-Regulation’ “What you see happening on Jan. 10 is the most sweeping re-regulation of mortgage finance that I’ve seen,” said Pete Mills, senior vice president of residential policy at the Mortgage Bankers Association, whose home loan career started in 1983.

Unlike the loose lending practices of the last decade, most lenders now approve borrowers only after fully documenting their incomes and assets. At a time when government-backed loans account for 90 percent of the market, non-qualified mortgages can’t be insured by the Federal Housing Administration or sold to Fannie Mae or Freddie Mac, the government-controlled enterprises that package home loans into bonds.

Changing Structure Wells Fargo wants to give its clients more loans that can’t be sold to the government-backed firms. The bank is confident the new underwriting group, which will make both qualified and non-qualified mortgages, will allow it to originate debt that doesn’t meet the CFPB’s safe harbor, said Blackwell. Non-qualified mortgages could be about 5 percent of the bank’s total mortgage production, he said.

The approach represents a change for the bank, which long made loans with the intention of selling them all.

“In the early days of our history, we were a mortgage bank: our primary responsibility was to originate and sell,” Blackwell said. “Today we are originating for our portfolio. These are loans that we will hold for their lifetime.”

Wells Fargo added $14.5 billion in nonconforming mortgages in the six months ended September, bringing the total held by the bank to $72.4 billion, according to a bank presentation.

Bank of the West, a subsidiary of BNP Paribas SA (BNP), also plans to offer non-qualified mortgages to its clients regardless of amount, according to Stew Larsen, executive vice president of the mortgage banking division based in Omaha, Nebraska. The rules are an opportunity for banks that have capacity to hold loans on their balance sheets to take market share from mortgage companies that lack that capability, he said.

Potential Expansion Non-qualified mortgages have the potential to be a $400 billion a year market, starting with the most creditworthy borrowers and broadening as home values and the wider economy improve, according to Raj Date, who stepped down as deputy director of the CFPB a year ago to found Fenway Summer LLC, which plans to offer non-conforming loans in 2014.

Lenders are responding to mortgage volumes that are forecast to plunge 33 percent this year to $1.17 trillion from 2013, according to the Mortgage Bankers Association. Rates on 30-year mortgages averaged 4.53 percent last week, up from 3.35 percent in early May, according to Freddie Mac.

The rate increased when the Federal Reserve signaled plans to reduce $85 billion in monthly bond purchases and already has diminished the refinancing that accounted for two-thirds all home loans in the last two years.

Refinancing Declines Declines in refinancing have led the largest lenders to start cutting jobs. JPMorgan (JPM) Chase & Co. said it may dismiss 15,000 employees, Wells Fargo cut more than 6,200 positions and Bank of America Corp. (BAC) eliminated at least 3,400 mortgage-related workers. Citigroup Inc. (C) also said it’s looking to trim staff.

Banks are being cautious about testing the limits of the new rules as they continue settling disputes arising from the last decade’s lending spree.

JPMorgan, which agreed to pay $5.1 billion in October to resolve claims by Fannie Mae and Freddie Mac about debt sold to the financing companies, has no plans to expand or discontinue products after Jan. 10, including non-qualified mortgages for borrowers with a high-net worth, according to Amy Bonitatibus, a spokeswoman for the New York-based bank.

Bank of America will continue providing interest-only loans to “preferred customers in a very conservative manner,” according to bank spokesman Terry Francisco.

Citigroup Offering Citigroup will offer some loans such as adjustable-rate mortgages and those too large to qualify for agency guidelines, according to Mark Rodgers, a bank spokesman. The loans will only be made when they are “appropriate and suitable” for borrowers, he said.

The new rules will help protect consumers and reduce the risk that the economy will crash again because of shoddy lending, Senator Elizabeth Warren, a Democrat of Massachussetts, said yesterday.

“The rules will reshape the mortgage market for the better,” Warren, who first proposed creating the CFPB, said during a floor speech. “They will give people a better chance to buy homes and a better chance to keep those homes, and they will force mortgage lenders and servicers to compete by offering better rates and customer service, not by tricking and trapping people. ”

Initial Reluctance While lenders initially will be reluctant to extend non-qualified mortgages to borrowers with lower incomes, limited assets or low credit scores, they will probably stretch the rules as they seek to expand business, just as they began offering loans to subprime borrowers in the last decade, according to Richard Eckert, an MLV & Co. analyst who worked as a risk management analyst at the Federal Home Loan Bank of San Francisco in the 1990s.

“Just like back in the early 2000s, to keep the party rolling they slipped into subprime,” he said. “People that were high and mighty and were going to take the high road a year ago when quarterly loan originations were $400 billion and now seeing those dry up to as little as $150 billion, I think they are taking a real hard look at what they may have passed up.”

Even as it cuts mortgage jobs, Wells Fargo has selected between 300 and 400 underwriters who will execute different policies and report to separate bosses than peers who check over loans the bank sells to investors, Blackwell said in a telephone interview.

Separate Groups “We have separated the underwriting group into a separate team that only underwrites loans” for the bank’s own balance sheet, he said. “We found it impossible to achieve our objectives” with the two groups together, he said.

The underwriters will be located in six locations around the country and the training of the group and policy writing will be completed by the end of the year, Blackwell said.

This may lead to faster closing times and fewer mistakes, according to Joseph Morford, an RBC Capital Markets analyst based in San Francisco. That should build trust with the company’s financial advisers and private bankers, who are expected to refer wealthy customers, he wrote in a Dec. 23 note to clients.

“The brokers should feel more comfortable that their customers will be handled appropriately, which over time should lead to more mortgage referrals,” Morford wrote after meeting with David Carroll, head of Wells Fargo’s wealth and retirement unit.

Already, the new policy has “allowed us to do more volume with better service and better quality,” Blackwell said.


_____________________________________________
MIND YOU, SOME OF THESE RULES ARE FINE.  WE NEVER BELIEVED A LAW WAS NEEDED TO REQUIRE A BANK TO CHECK PERSONAL QUALIFICATIONS LIKE INCOME AND EMPLOYMENT.....THAT WAS FRAUD.  THE 45% OF MONTHLY INCOME WOULD NOT BE BAD IF PRICES FOR HOMES WERE NOT SO HIGH FOR EXAMPLE IN CITIES.

Keep in mind the mortgage crisis was created by Wall Street and it is these same requirements in this bill placed on homeowners that was needed on banks to stop the next crisis......20% capital on hand in the banks has never happened and they are now leveraged with derivative debt beyond the $600 trillion of last economic crash.  So, Wall Street and the Consumer Financial Protection Bureau is placing the requirements needed for banks in these mortgage rules for consumers.


Let's look at jumbo mortgage loans for example.

The first thing our neo-liberal Obama and Congress did when they were elected in 2008 was to extend Federal protection FHA for loans to a whopping $700, 000.  Keep in mind the FHA is a low-income agency. 

They did this so affluent homeowners could qualify for all the mortgage write-downs and low-interest refinancing that was supposedly helping main street keep their homes.  Most of the money spent in this Federal program went to these $700,000 homeowners while main street went into foreclosure by the tens of millions.  So, we now have a Federal agency insuring home loans for hundreds of thousands of dollars-----JUMBO MORTGAGES.  Why end that now?  Because these five years of Obama's term has moved those tens of millions of foreclosed homes and refinanced those high-end mortgages all that is needed and now they are ready to handle the mortgage market in a way most profitable. 




How will new mortgage rules affect you?

By Polyana da Costa • Bankrate.com Highlights
  • The mortgage rules are designed to ensure that borrowers can repay.
  • Jumbo loans will be harder to qualify for; interest-onlies will be rare.
  • Homeowners will get renewed protections when they fall behind on payments.


The home loan industry will soon have to adapt to new mortgage rules that will offer borrowers much needed protection against lender abuses and reckless lending standards. But the changes may not please all borrowers.

Some of the new mortgage rules the Consumer Financial Protection Bureau has issued this year will influence qualification requirements and the types of mortgages that borrowers get. The new standards go into effect next year -- but expect lenders to start adjusting to the new policies in coming months.

The gist of one of the main rules is simple: Lenders will be required to ensure that borrowers have the ability to repay their mortgages. In return, lenders will be protected from borrower lawsuits so long as they issue "safe" mortgages that follow guidelines.

These safe mortgages are what the CFPB calls "qualified mortgages." As defined by the CFPB, only 12.8 percent of new mortgages in 2012 didn't meet the "qualified mortgage" standard, according to real estate data provider CoreLogic.

The new mortgage rules won't affect the majority of people seeking to buy a home or refinance their home loans, because lenders have already tightened their lending standards since the financial crisis.

But certain groups of borrowers will notice a difference, analysts say. This is especially true for borrowers seeking larger mortgages. Self-employed borrowers also may need to jump through additional hoops to get a home loan.

"There are all sorts of ways to prove income, but what's no longer at the table is just asserting that you make X dollars per year," says Julia Gordon, director of housing finance and policy for the Center for American Progress and former manager of single-family policy at the Federal Housing Finance Agency.


What will change for jumbo loans?Mortgage professionals in high-cost areas say they worry that the new rules may create obstacles for some borrowers seeking large loans to buy or refinance a home. That's partly because a mortgage that falls outside of the conforming and Federal Housing Administration loan limits (which vary between $417,000 and $729,750) will not be considered a qualified mortgage if the borrower's debt payments exceed 43 percent of monthly income.

About 9 percent of jumbo loans issued in 2012 went to borrowers with debt-to-income ratios higher than 43 percent, CoreLogic data show.

"A 45 percent debt ratio seems to be slightly more common than a 43 percent ratio these days, so lenders will most likely reduce their max ratios for nonagency loans," says Matt Hackett, operations manager for Equity Now in New York City.

Interest-only loans will be harder to findBorrowers who rely on interest-only loans will see changes, because loans that don't require borrowers to pay principal during an initial period are not considered a qualified mortgage under the CFPB's rules.

These loans were widely available during the housing boom and contributed to the crisis, as many homeowners couldn't handle the larger payments once the initial interest-only period expired. Most lenders have stopped offering interest-only loans, but they are still popular for jumbo mortgages and in high-cost areas.



___________________________________________


Bank of America Loan Modification Plan Requirements Explained Posted by admin On April - 27 - 2011

What does it take to get approved for a Bank of America loan modification?  What are the requirements for approval that homeowners need to meet in order to get a lower mortgage payment?  These are questions that most borrowers need answers to – and it is important to know the answers before you send in your application.  Here is some helpful information on the specific requirements used for the loan modification plan.

Bank of America Loan Modification Requirements:

The government has mandated that every homeowner who asks to be reviewed for this program must be given the chance and during the review process their home cannot be foreclosed.

  1. for owner occupied homes only – so it will not HAMP Loan Mod Program work for rental property or second homes.  Bank of America may have an in house plan that can be used on those types of loans.

  2. You must be facing a financial hardship situation – this means that due to circumstances out of your control your current mortgage payment is not affordable and you are at risk of default.  Loss of home value alone is not a valid reason for a loan modification – some good reasons are loss or reduction in income, increased expenses, medical bills, divorce, military, lack of reserves, high debt
  3. The  plan is only for loans with a balance less than $729,750 and those that were taken out before January 1, 2009.  Jumbo loans will not qualify, but you can request a Bank of America in house loan mod if your loan balance is too high.
  4. Your current mortgage payment must equal more than 31% of your household gross monthly income – this calculation is called debt ratio and it is a big part of the approval requirements.
  5. Your monthly income, monthly expenses and current bank balances must fit within a standard approval formula that Bank of America uses.  This is called the Waterfall Method of Modification-if your income is too high or too low you will not qualify.  You may want to Sample Budget-Automatically!

    run your own monthly budget through the loan modification software calculator in order to be sure that your figures are acceptable before submitting it for review.

Below you see that the mortgage loans above $417,000 are the jumbo loans.  As the article below this shows.......refinancing of jumbo loans in CA, NJ, NY, and FL over what was then this $417,000 limit sky-rocketed and Obama and neo-liberals in Congress raised that to $700,000 to cover that difference.....

IT WAS A DELIBERATE MOVE TO COVER WHAT WERE ILLEGAL REFINANCING ABOVE AMOUNTS SET BY THE FHA CREATING HUNDREDS OF BILLIONS OF DOLLARS IN PROFIT.  SEE WHY THIS NEW MORTGAGE RULE NOW FORBIDS THIS!  THE DEAL IS DONE!


So, we hear in the press that Jumbo Mortgages will not be included in Obama's bailout and then we see that indeed, jumbo loans are what was intended for bailout.  Think about the states committing these crimes all for billions in bank profits and the fact that most of them are neo-liberal. 


Three Options for Refinancing a Jumbo Home Loan With Reduced Income [Aug 5, 2009.]

For homeowners with home loan amounts of $417,000 or less, the Obama Administration's Home Affordable Refinance Program can help get that tough refinance done. This so-called "conforming loan limit" is acting as a sort of dividing line between those who are eligible for government mortgage refinance assistance and those who aren't.

It's not really a surprise, then, that many holders of jumbo home loans (loans above $417,000) are feeling a sense of hopelessness about refinancing their home loan. This hopelessness can set in especially hard for borrowers suffering from reduced income due to unemployment or cut hours.

But before giving up, consider these three options for refinancing a jumbo home loan:

1. Jumbo Loans May Qualify for the Home Affordable Modification Program

 Although it's true that the Home Affordable Refinance Program does not apply to jumbo loans, the Obama Administration's Home Affordable Modification Program does contain eligibility for certain jumbo mortgages. Check out the details of the program here.

Borrowers who are paying more than 31 percent of their income to housing expense (mortgage, taxes, insurance) may qualify for this modification program--even for jumbo home loans.

2. Get a Co-Signer

Not the most appealing option in the universe, sure, but tough times call for tough measures. If Mom and Dad are sitting on a paid off house, have ample retirement savings, and don't want to see their children (or grandchildren) suffer the impact of a foreclosure, co-signing may be the best option available.

Especially in the case of reduced income, Mom and Dad's income can make a difficult refi possible.

3. Contact (Harass) the Bank Repeatedly

Not to put it bluntly, but borrowers whose debt-to-income ratios have been skewed for the worse by reduced income have to work a lot harder for a jumbo loan refinance than the rest of America. Part of this hard work entails contacting a lender directly and trying to work out a plan that respects borrower circumstances.

But don't just base such arguments on an emotional appeal. If good credit history is there, if unemployment is the reason why a refi is temporarily impossible, if job leads are coming down the pike, mention all that and more. Develop a personal relationship with the lender if at all possible.

And use numbers to make it clear that a foreclosure is in no one's best interests. Here are some foreclosure cost figures that help make the point that refinancing is the best option for both the borrower and the bank.

_______________________________________________

FHA loan limit back up to $729,750


Tuesday November 22, 2011 11:30 AM By Ellen Yan


Home loan borrowers will once again be able to get federally guaranteed loans of up to $729,750 on Long Island -- but only from the Federal Housing Administration.

The new law that funds five federal departments, including the Department of Housing and Urban Development, did not extend the higher limit, which had expired Oct. 1, to loans guaranteed by mortgage finance giants Fannie Mae and Freddie Mac.

President Barack Obama on Friday signed the measure after the final congressional vote on Thursday. The Federal Housing Administration extension expires Dec. 31, 2013.

Republicans in the House had stripped the extension for Fannie and Freddie, which are overseen by the Federal Housing Finance Agency.

The report from House and Senate negotiators on the bill cited the two agencies' "questionable business practices" and "extravagant management bonuses."

The finance agency's acting director, Edward J. DeMarco, had defended millions of dollars in pay for Fannie and Freddie executives, saying "competent executives" were needed during these challenging times.

But congressional negotiators said they allowed the extension for FHA loans because it is subject to "greater congressional scrutiny."

The federally guaranteed loan limit was raised from $625,500 in 2008 as a temporary measure to give the housing market a boost. Federally guaranteed loans are less risky for investors, and when lenders sell these loans on Wall Street, this frees up capital for the lenders to lend again.

But as the loan limit was due to expire Oct. 1, supporters called for another extension because the housing market was still weak, while opponents saw it as a subsidy for the rich to buy expensive homes. Anything over the limit is considered a "jumbo loan," which usually carries higher interest rates and down payments.

Rep. Gary Ackerman (D-Roslyn Heights), who helped lead the charge to extend the limits, fired back at Republicans in a Friday statement: "By not fully restoring the loan limits, they have deprived a large portion of the housing market of its main source of liquidity in the middle of the most catastrophic housing crisis since the Great Depression."

He said he would push legislation to give Fannie and Freddie the higher loan limits.



_______________________________________________
Requiring 20% down for a FHA loan?????  REALLY????

SHOUT OUT TO THE FEDERAL AGENCIES BELOW THAT WE DO NOT WANT THESE DOWN-PAYMENT REQUIREMENTS!


What caused so many people with low-income loans to default was the fact that when families sign these loans they expect to have 30 years to pay them.  So, they know they will have to grow in income to meet these loans.  What they did not know was that Wall Street was blowing up the market and a crash would bring the conditions of long-term unemployment, lost retirements/savings from fraud that we have yet to have justice!  So, where some people were playing the loose lending and flipping houses.....most people were simply ordinary people feeling sure that in 30 years they could pay for those houses.  STATISTICS SHOW THAT WITH FHA LOANS IN THE PAST....THIS IS TRUE.

So, requiring this high of a down-payment is not necessary, it is simply to keep most people out of the home-ownership arena.  Keep in mind that 80% of Americans are now at poverty line.


FHA down payment - Wikipedia

A borrower's down payment may come from a number of sources. The 3.5% requirement can be satisfied with the borrower using their own cash or receiving a gift from a family member, their employer, labor union, or government entity.


Below you see that historically a 31% of income has been recommended, not required.  This new rule now requires a 45% of income and that is a huge jump for an agency created to help low-income people.

FHA Qualifying Ratio Explained

Also known as debt to income ratio, the FHA permissible qualifying ratio is simply expressed as the fraction of your gross monthly income that goes toward your monthly recurring expenses. The FHA permissible qualifying ratio is divided into two main categories:

  1. Mortgage Payment Expense to Effective Income Ratio: This ratio focuses only on your mortgage payment expense in relation to your gross income. The FHA guidelines recommend a qualifying ratio of 31 percent for your total mortgage payment expense to effective income. The FHA sets a higher ratio of 33 percent if your home qualifies under the Energy Efficient Homes (EEH) program.





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    Cindy Walsh is a lifelong political activist and academic living in Baltimore, Maryland.

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