John M. Starcher Jr., made about $6 million in 2020, according to the most recent tax filings.

“Our mission is clear — to extend the compassionate ministry of Jesus by improving the health and well-being of our communities and bring good help to those in need, especially people who are poor, dying and underserved,” the spokeswoman, Maureen Richmond, said. Bon Secours did not comment on Mr. Otey’s case.

In interviews, doctors, nurses and former executives said the hospital had been given short shrift, and pointed to a decade-old development deal with the city of Richmond as another example.

In 2012, the city agreed to lease land to Bon Secours at far below market value on the condition that the chain expand Richmond Community’s facilities. Instead, Bon Secours focused on building a luxury apartment and office complex. The hospital system waited a decade to build the promised medical offices next to Richmond Community, breaking ground only this year.

founded in 1907 by Black doctors who were not allowed to work at the white hospitals across town. In the 1930s, Dr. Jackson’s grandfather, Dr. Isaiah Jackson, mortgaged his house to help pay for an expansion of the hospital. His father, also a doctor, would take his children to the hospital’s fund-raising telethons.

Cassandra Newby-Alexander at Norfolk State University.

got its first supermarket.

according to research done by Virginia Commonwealth University. The public bus route to St. Mary’s, a large Bon Secours facility in the northwest part of the city, takes more than an hour. There is no public transportation from the East End to Memorial Regional, nine miles away.

“It became impossible for me to send people to the advanced heart valve clinic at St. Mary’s,” said Dr. Michael Kelly, a cardiologist who worked at Richmond Community until Bon Secours scaled back the specialty service in 2019. He said he had driven some patients to the clinic in his own car.

Richmond Community has the feel of an urgent-care clinic, with a small waiting room and a tan brick facade. The contrast with Bon Secours’s nearby hospitals is striking.

At the chain’s St. Francis Medical Center, an Italianate-style compound in a suburb 18 miles from Community, golf carts shuttle patients from the lobby entrance, past a marble fountain, to their cars.

after the section of the federal law that authorized it, allows hospitals to buy drugs from manufacturers at a discount — roughly half the average sales price. The hospitals are then allowed to charge patients’ insurers a much higher price for the same drugs.

The theory behind the law was that nonprofit hospitals would invest the savings in their communities. But the 340B program came with few rules. Hospitals did not have to disclose how much money they made from sales of the discounted drugs. And they were not required to use the revenues to help the underserved patients who qualified them for the program in the first place.

In 2019, more than 2,500 nonprofit and government-owned hospitals participated in the program, or more than half of all hospitals in the country, according to the independent Medicare Payment Advisory Commission.

in wealthier neighborhoods, where patients with generous private insurance could receive expensive drugs, but on paper make the clinics extensions of poor hospitals to take advantage of 340B.

to a price list that hospitals are required to publish. That is nearly $22,000 profit on a single vial. Adults need two vials per treatment course.

work has shown that hospitals participating in the 340B program have increasingly opened clinics in wealthier areas since the mid-2000s.

were unveiling a major economic deal that would bring $40 million to Richmond, add 200 jobs and keep the Washington team — now known as the Commanders — in the state for summer training.

The deal had three main parts. Bon Secours would get naming rights and help the team build a training camp and medical offices on a lot next to Richmond’s science museum.

The city would lease Bon Secours a prime piece of real estate that the chain had long coveted for $5,000 a year. The parcel was on the city’s west side, next to St. Mary’s, where Bon Secours wanted to build medical offices and a nursing school.

Finally, the nonprofit’s executives promised city leaders that they would build a 25,000-square-foot medical office building next to Richmond Community Hospital. Bon Secours also said it would hire 75 local workers and build a fitness center.

“It’s going to be a quick timetable, but I think we can accomplish it,” the mayor at the time, Dwight C. Jones, said at the news conference.

Today, physical therapy and doctors’ offices overlook the football field at the training center.

On the west side of Richmond, Bon Secours dropped its plans to build a nursing school. Instead, it worked with a real estate developer to build luxury apartments on the site, and delayed its plans to build medical offices. Residents at The Crest at Westhampton Commons, part of the $73 million project, can swim in a saltwater pool and work out on communal Peloton bicycles. On the ground floor, an upscale Mexican restaurant serves cucumber jalapeño margaritas and a Drybar offers salon blowouts.

have said they plan to house mental health, hospice and other services there.

a cardiologist and an expert on racial disparities in amputation, said many people in poor, nonwhite communities faced similar delays in getting the procedure. “I am not surprised by what’s transpired with this patient at all,” he said.

Because Ms. Scarborough does not drive, her nephew must take time off work every time she visits the vascular surgeon, whose office is 10 miles from her home. Richmond Community would have been a five-minute walk. Bon Secours did not comment on her case.

“They have good doctors over there,” Ms. Scarborough said of the neighborhood hospital. “But there does need to be more facilities and services over there for our community, for us.”

Susan C. Beachy contributed research.

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They Were Entitled to Free Care. Hospitals Hounded Them to Pay.

In 2018, senior executives at one of the country’s largest nonprofit hospital chains, Providence, were frustrated. They were spending hundreds of millions of dollars providing free health care to patients. It was eating into their bottom line.

The executives, led by Providence’s chief financial officer at the time, devised a solution: a program called Rev-Up.

Rev-Up provided Providence’s employees with a detailed playbook for wringing money out of patients — even those who were supposed to receive free care because of their low incomes, a New York Times investigation found.

nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.

But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.

focused on investments in rich communities at the expense of poorer ones.

And, as Providence illustrates, some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result, in the case of Providence, is that thousands of poor patients were saddled with debts that they never should have owed, The Times found.

provide. That was below the average of 2 percent for nonprofit hospitals nationwide, according to an analysis of hospital financial records by Ge Bai, a professor at the Johns Hopkins Bloomberg School of Public Health.

Ten states, however, have adopted their own laws that specify which patients, based on their income and family size, qualify for free or discounted care. Among them is Washington, where Providence is based. All hospitals in the state must provide free care for anyone who makes under 300 percent of the federal poverty level. For a family of four, that threshold is $83,250 a year.

In February, Bob Ferguson, the state’s attorney general, accused Providence of violating state law, in part by using debt collectors to pursue more than 55,000 patient accounts. The suit alleged that Providence wrongly claimed those patients owed a total of more than $73 million.

Providence, which is fighting the lawsuit, has said it will stop using debt collectors to pursue money from low-income patients who should qualify for free care in Washington.

But The Times found that the problems extend beyond Washington. In interviews, patients in California and Oregon who qualified for free care said they had been charged thousands of dollars and then harassed by collection agents. Many saw their credit scores ruined. Others had to cut back on groceries to pay what Providence claimed they owed. In both states, nonprofit hospitals are required by law to provide low-income patients with free or discounted care.

“I felt a little betrayed,” said Bev Kolpin, 57, who had worked as a sonogram technician at a Providence hospital in Oregon. Then she went on unpaid leave to have surgery to remove a cyst. The hospital billed her $8,000 even though she was eligible for discounted care, she said. “I had worked for them and given them so much, and they didn’t give me anything.” (The hospital forgave her debt only after a lawyer contacted Providence on Ms. Kolpin’s behalf.)

was a single room with four beds. The hospital charged patients $1 a day, not including extras like whiskey.

Patients rarely paid in cash, sometimes offering chickens, ducks and blankets in exchange for care.

At the time, hospitals in the United States were set up to do what Providence did — provide inexpensive care to the poor. Wealthier people usually hired doctors to treat them at home.

wrote to the Senate in 2005.

Some hospital executives have embraced the comparison to for-profit companies. Dr. Rod Hochman, Providence’s chief executive, told an industry publication in 2021 that “‘nonprofit health care’ is a misnomer.”

“It is tax-exempt health care,” he said. “It still makes profits.”

Those profits, he added, support the hospital’s mission. “Every dollar we make is going to go right back into Seattle, Portland, Los Angeles, Alaska and Montana.”

Since Dr. Hochman took over in 2013, Providence has become a financial powerhouse. Last year, it earned $1.2 billion in profits through investments. (So far this year, Providence has lost money.)

Providence also owes some of its wealth to its nonprofit status. In 2019, the latest year available, Providence received roughly $1.2 billion in federal, state and local tax breaks, according to the Lown Institute, a think tank that studies health care.

a speech by the Rev. Dr. Martin Luther King Jr.: “If it falls your lot to be a street sweeper, sweep streets like Michelangelo painted pictures.”

Ms. Tizon, the spokeswoman for Providence, said the intent of Rev-Up was “not to target or pressure those in financial distress.” Instead, she said, “it aimed to provide patients with greater pricing transparency.”

“We recognize the tone of the training materials developed by McKinsey was not consistent with our values,” she said, adding that Providence modified the materials “to ensure we are communicating with each patient with compassion and respect.”

But employees who were responsible for collecting money from patients said the aggressive tactics went beyond the scripts provided by McKinsey. In some Providence collection departments, wall-mounted charts shaped like oversize thermometers tracked employees’ progress toward hitting their monthly collection goals, the current and former Providence employees said.

On Halloween at one of Providence’s hospitals, an employee dressed up as a wrestler named Rev-Up Ricky, according to the Washington lawsuit. Another costume featured a giant cardboard dollar sign with “How” printed on top of it, referring to the way the staff was supposed to ask patients how, not whether, they would pay. Ms. Tizon said such costumes were “not the culture we strive for.”

financial assistance policy, his low income qualified him for free care.

In early 2021, Mr. Aguirre said, he received a bill from Providence for $4,394.45. He told Providence that he could not afford to pay.

Providence sent his account to Harris & Harris, a debt collection company. Mr. Aguirre said that Harris & Harris employees had called him repeatedly for weeks and that the ordeal made him wary of going to Providence again.

“I try my best not to go to their emergency room even though my daughters have gotten sick, and I got sick,” Mr. Aguirre said, noting that one of his daughters needed a biopsy and that he had trouble breathing when he had Covid. “I have this big fear in me.”

That is the outcome that hospitals like Providence may be hoping for, said Dean A. Zerbe, who investigated nonprofit hospitals when he worked for the Senate Finance Committee under Senator Charles E. Grassley, Republican of Iowa.

“They just want to make sure that they never come back to that hospital and they tell all their friends never to go back to that hospital,” Mr. Zerbe said.

The Everett Daily Herald, Providence forgave her bill and refunded the payments she had made.

In June, she got another letter from Providence. This one asked her to donate money to the hospital: “No gift is too small to make a meaningful impact.”

In 2019, Vanessa Weller, a single mother who is a manager at a Wendy’s restaurant in Anchorage, went to Providence Alaska Medical Center, the state’s largest hospital.

She was 24 weeks pregnant and experiencing severe abdominal pains. “Let this just be cramps,” she recalled telling herself.

Ms. Weller was in labor. She gave birth via cesarean section to a boy who weighed barely a pound. She named him Isaiah. As she was lying in bed, pain radiating across her abdomen, she said, a hospital employee asked how she would like to pay. She replied that she had applied for Medicaid, which she hoped would cover the bill.

After five days in the hospital, Isaiah died.

Then Ms. Weller got caught up in Providence’s new, revenue-boosting policies.

The phone calls began about a month after she left the hospital. Ms. Weller remembers panicking when Providence employees told her what she owed: $125,000, or about four times her annual salary.

She said she had repeatedly told Providence that she was already stretched thin as a single mother with a toddler. Providence’s representatives asked if she could pay half the amount. On later calls, she said, she was offered a payment plan.

“It was like they were following some script,” she said. “Like robots.”

Later that year, a Providence executive questioned why Ms. Weller had a balance, given her low income, according to emails disclosed in Washington’s litigation with Providence. A colleague replied that her debts previously would have been forgiven but that Providence’s new policy meant that “balances after Medicaid are being excluded from presumptive charity process.”

Ms. Weller said she had to change her phone number to make the calls stop. Her credit score plummeted from a decent 650 to a lousy 400. She has not paid any of her bill.

Susan C. Beachy and Beena Raghavendran contributed research.

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Mental Health America: Texas Ranks Last In Mental Health Care Access

Canutillo Independent School District and Kingsville Independent School District try to get a handle on mental health care for students in need.

The old saying is “everything is bigger in Texas” — including its problems. 

Mental health ranks atop.  

In the wake of the Uvalde massacre, conservative politicians are waving away talk of gun control and stressing that mental health is the real culprit. And in boastful Texas, mental health is a big problem.  

Mental Health America ranks Texas dead last in access to mental health care. The Kaiser Family Health Foundation found that Texans suffer depression at higher-than-average rates. 

In data released by the Texas Education Agency, more than half of Lone Star schools don’t have a psychologist or access to telehealth.

Texas has also opted out of Medicaid expansion under the Affordable Care Act. In various studies, that amounts to tens of billions of dollars in federal funding, which could insure more than a million Texans and provide reimbursements for mental health professionals.  

Canutillo Independent School District is north of El Paso, Texas. It’s like Uvalde, with a supermajority Hispanic population and a mental health desert. It’s chief concern is access for those services for its 6,200 students 

“So, one of the things that is most important is social workers, counselors and prevention specialists working together,” social worker Rosario Olivera said.

The school district is Title I funded, meaning more than 40% of its students fall below the poverty line.

Administrators grappled with various problems across 10 schools, like how to get students access to medical care and in a pandemic, access to mental health and more counselors.

“We do the best we can do to service children of highest need,” Olivera continued. “However, it’s the same thing as with counselors. The ratio is very high.”

In Canutillo, it meant a pilot program of bringing in social workers and social work interns from the University of Texas El Paso.

“For every campus that has 350 students, you need one counselor. The majority of our campuses have 500 and above,” Canutillo Independent School District Director of Student Support Services Monica Reyes said.

Another glaring indicator in mental health access is poverty.

“This is typically what you’ll see: A mobile home with six or seven family members in it,” said Francisco Mendez with Familia Triunfadores.

In the colonias of San Elizario, access to mental health is a question of whether there are any therapists close by. But oftentimes, the answer is no. 

“It’s really difficult for them,” Mendez said. “They’ll have to drive at least 35 miles to El Paso.”  

In Kingsville, Texas, the schools have one mental health professional for more than 2,800  students.

Tracy Warren is a licensed school specialist psychologist, or LSSP. She’s an intern completing her doctorate. The challenge for Kingsville Independent School District is holding on to her and getting more people like her.

“We are trying to let everybody know how important mental health is and that if we don’t have the mental health foundation, the education is not going to take place,” Warren said. 

She is the front line. The school district leans on nonprofits to help kids outside of class. 

“There are a lot more anxious students this year than I’ve ever seen,” Warren continued. “We actually had a student that was at one of our campuses — he’s 4, going into Pre-K. First day of school, he stopped outside to count the police cars that he can see to ensure that he was safe before he came into school.”

The small school district’s leader, Superintendent Cissy Reynolds-Perez, says more mental health professionals and counselors need to be trained to work in rural schools.

“It’s very difficult because not everybody wants to come out to this area,” she said. “You know, you have your metropolitan areas, which I’m not saying it’s easier, but there are more resources there.”

At nearby Texas A&M Kingsville, the school has opened an institute for rural mental health.

Steve Bain is the director of the Rural Mental Health Institute. His goal is to create a mental health graduate student counselor pipeline direct to public schools.

“We have an opportunity now to reverse this trend of being last, or toward the last, in terms of accessibility of mental health services,” he said. “Only about 25% of students in K-12 who suffer from depression are getting mental health services. And depression has increased among our student population in the last five to eight years, significantly so.”

In Texas, licensed school specialty psychologists and social workers can be mental health caregivers to emotionally fraught kids, but there is a catch.

“Texas Education Agency has not recognized social workers as TEA employees yet, per se. We don’t have a specific job description, like teachers or counselors do,” Olivera said. 

That means school districts miss out on funding and insurance reimbursements when social workers provide mental health care for kids.

Newsy’s mental health initiative “America’s Breakdown: Confronting Our Mental Health Crisis” brings you deeply personal and thoughtfully told stories on the state of mental health care in the U.S. Click here to learn more.

Source: newsy.com

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Hospital ERs Struggle To Treat Surge Of Mental Health Patients

A Newsy investigation finds more Americans are going to the ER during a mental health crisis, and why they aren’t getting the help they need.

More Americans going through a mental health crisis are seeking care in hospital emergency rooms not always equipped to give the psychiatric care they need, a Newsy investigation has learned. 

Breia Birch, 44, suffers from bipolar, post-traumatic stress and dissociative identity disorders. 

She began thinking about suicide after her mother’s death in 2017. 

“I remember sitting down at my table and getting my pills out,” Birch said. “I started to separate out the ones that would hurt or hurt me out of the pile of pills. I was trying to kill myself.”

She went to her local emergency room in Manhattan, Kansas, for help. 

“Unfortunately, there aren’t many places in Kansas where you can go and get screened. You have to go to the ER,” Birch said.  

Across the country, mental health-related ER visits shot up 66 percent from 2013-2018, according to a study published in the Western Journal of Emergency Medicine. 

“Our rooms are full,” said Robyn Chadwick, president of Ascension Via Christi St. Joseph hospital in Wichita, Kansas. 

“Every single day in this facility, we have patients who are suicidal or homicidal,” Chadwick said. “On a good day, there will be 10 behavioral health patients waiting in the emergency room. On a really bad day, there might be 30.”

Nationally, bed capacity for psychiatric patients has plummeted in recent decades. 

Care outside the hospital can also be hard to find. An audit from the Government Accountability Office this spring found mental health patients with insurance “experience challenges finding in-network providers.” 

Patients also face a shortage of psychiatrists willing to accept Medicaid. Emergency rooms are also coping with a surge in behavioral health visits related to substance abuse. 

“Substance abuse and mental health have always gone hand-in-hand,” Chadwick said. 

Patients with nowhere else to go are flooding emergency rooms.

“Whatever that mental illness is, if you can’t get help, the situation gets worse, it escalates,” Chadwick said. “The emergency room is the safety net for everything.” 

The problem is, hospital emergency rooms are struggling with the influx of patients who, like Birch, are desperate for help. 

The ER closest to her in Manhattan, Kansas, was like many nationwide that don’t have a behavioral health unit. 

“They couldn’t find me anywhere to go for mental health,” Birch said. 

She was so desperate for care, she steered herself in a wheelchair toward traffic outside the ER so she could get into a state hospital. 

“I did what I had to do to get help,” Birch said. 

A Newsy analysis of data from the Centers for Disease Control and Prevention found of all psychiatric patients who go to the ER, about 11 percent leave without a follow-up plan for care.

Eleven percent may not sound like much, but it equals hundreds of thousands of patients in mental distress leaving the ER without a referral for future treatment. 

Chadwick says too many hospitals are not able to meet the need. 

The hospital she leads in Wichita built a new space to expand behavioral health treatment. 

“There are special screws used that cannot be pried out because a screw could then be used to harm yourself,” Chadwick said. 

To prevent suicide by hanging, doors have special handles. Televisions mounted to the wall don’t have exposed cords. 

The build-out took money: about $60 million. It also took determination.

“It has become very personal,” Chadwick said. “My oldest daughter, who’s now 22, attempted suicide twice as a freshman in high school. And it really hit home. She’s what drives me to make sure that everyone who needs care gets it.” 

Outside the hospital, leaders in Sedgwick County surrounding Wichita established a rapid response team to help with mental health related 911 calls when people may not need the ER.

They also set aside $15 million for a new mental health community crisis center. 

County Commissioner Lacey Cruse envisions an area between the hospital and jail could be used to help psychiatric patients before they need emergency help. 

“What we need really is like sort of a one-stop-shop,” Cruse said. “Let’s make sure they have transportation and get there. And then let’s follow up with them. You can’t teach someone to swim when they’re in the middle of the ocean drowning.”

The county has not settled on when or where to build the new center. 

Medication and a caregiver are helping Birch’s mental health, four years after struggling for emergency room care.  

“I have to keep reminding myself that I really don’t have too much to complain about right now,” Birch said. “I’m just doing a lot better now and I just hope I stay on this path.” 

If you need to talk to someone, call the National Suicide Prevention Lifeline by dialing 988 or text “HOME” to the Crisis Text Line at 741741.

Source: newsy.com

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West Virginia Legislature Passes Abortion Ban With Few Exceptions

By Associated Press
September 14, 2022

The legislation would allow victims of rape and incest to obtain abortions at up to eight weeks of pregnancy, if they report to law enforcement first.

West Virginia’s Legislature passed a sweeping abortion ban with few exceptions Tuesday, approving a bill that several members of the Republican supermajority said they hope will make it impossible for the state’s only abortion clinic to continue to offer the procedure.

“It is going to shut down that abortion clinic, of that I feel certain,” Republican Sen. Robert Karnes said on the Senate floor, amid shouts from protesters standing outside the chamber doors. “I believe it’s going to save a lot of babies.”

Under the legislation, rape and incest victims would be able to obtain abortions at up to eight weeks of pregnancy, but only if they report to law enforcement first. Such victims who are minors would have until 14 weeks to terminate a pregnancy and must report to either law enforcement or a physician.

Rape and incest victims would have to report the assault within 48 hours of getting an abortion, and a patient must present a copy of a police report or notarized letter to a physician before the procedure can be performed.

Abortions also would be allowed in cases of medical emergencies.

West Virginia joins the ranks of states moving to ban abortion in the aftermath of the U.S. Supreme Court’s decision earlier this year to end the constitutional right to privacy that protected abortion rights nationwide. That left it to states to decide whether abortion should remain legal, which in turn has ignited intense state-level debates, especially in states controlled by Republicans, about when to impose the ban, whether to carve out exceptions in cases involving rape, incest or the health of the woman giving birth, and how those exceptions should be implemented.

The West Virginia bill now heads to the desk of Republican Gov. Jim Justice, who has signed several anti-abortion bills into law since taking office in 2017. Lawmakers resumed debate on the bill Tuesday after failing to come to an agreement in late July, giving up the chance for the state to become the first to approve new legislation restricting access to abortions since the U.S. Supreme Court’s ruling in June removing its protected status as a constitutional right.

Both the Senate and the House of Delegates speedily approved the bill, after several hours of debate. Dozens of protesters wearing pink shirts reading “bans off our bodies” and holding signs reading “abortion is healthcare” staged a rally in the Capitol rotunda while lawmakers were in session.

Some of the group sat in the gallery as legislators discussed the bills, with some shouting down to legislators in frustration as they spoke in support of the bill. Legislative leadership asked that the onlookers remain silent as lawmakers conducted business. At one point, at least one protester was escorted out of the building by police. 

Lawmakers inserted several provisions they said were specifically targeted at the Women’s Health Center of West Virginia, which was the state’s first abortion clinic when it opened in 1976 following the U.S. Supreme Court’s landmark Roe v. Wade case. It has existed as the state’s sole abortion clinic for years, making it the ever-increasing target of anti-abortion lawmakers and protesters.

The bill states that surgical abortions can only be performed at a state-licensed hospital by a physician with hospital privileges. Anybody else who performs an abortion, including nurse practitioners and other medical professionals, could face three to 10 years in prison. A physician who performs an illegal abortion could lose their medical license.

Pregnant people who obtain illegal abortions will not face any form of prosecution under the bill, however.

Kaylen Barker, spokesperson for the Women’s Health Center of West Virginia, said the clinic will not be shutting down, even if the staff is no longer able to provide abortions. Like many clinics that perform abortions, the facility did not offer the procedure daily.

Most days are dedicated to services like gender-affirming hormone therapy, HIV prevention and treatment and routine gynecological care — cervical exams, cancer screenings — mostly for low-income patients on Medicaid with nowhere else to go.

Democratic Sen. Owens Brown, West Virginia’s only Black senator, spoke against the bill before it passed the Senate. He said when he looks around at his fellow lawmakers, he sees a body that is overwhelmingly comprised of white, middle-aged to elderly men who are middle-class or above.

Brown compared groups of men passing legislation that overwhelmingly impacts women to laws that were passed by white lawmakers when slavery was legal in the U.S. He said “all laws are not good laws made by men.”

“That’s somewhat irrational in many ways to be able to apply a law that will never apply to you,” he said to his fellow lawmakers. “It’s easy for you to sit there and do that because you will never have to face the consequences of your actions.”

Additional reporting by The Associated Press.

Source: newsy.com

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Student Loan Forgiveness Is Complicated, Because This Is America

If we want higher education to cost less, we should make it cheaper when people enroll.

But that’s not how we do things in the United States, where the first rule of personal finance is that it should never be simple.

Instead, we befuddle people with a menu of a half-dozen retirement accounts. We fetishize the tax code and its deductions and credits and refunds. We name gold, silver and bronze health insurance plans after precious metals but award no medals for clearing the enrollment hurdles.

And so it goes with President Biden’s executive action around student loan debt cancellation. The potential $20,000 in relief per person gets the headlines. But the sleeper element here is a new income-driven debt repayment plan that would help many people pay much less of their student loan debt over time, if they’re not big earners.

choose among H.M.O., P.P.O., P.F.F.S., S.N.P., H.M.O.-P.O.S. and M.S.A. plans. The Centers for Medicare & Medicaid Services website has an acronym glossary with 4,420 entries, because personal finance is its own language. You learn as you go, or not at all.

Pamela Herd is a professor at Georgetown University’s McCourt School of Public Policy, with an expertise in these “administrative burdens.”

With certain social welfare benefits, Professor Herd explained in an interview this week, the original program designers believed that obstacles were appropriate. Anyone desperate enough should find a way to muddle through and prove their poverty, or so the logic went.

More recently, administrative burdens have resulted from the conviction that private sector actors — who are often seeking profits — would be the most efficient intermediaries between people and federal programs that involved money.

You see it in those Medicare Advantage Plans, and it was a feature of federal P.P.P. loans during the early stages of the pandemic. Rather than give employers money up front to keep people on the payroll, there were forgivable loans that required frazzled small business owners to beg a banker to bum rush a balky government website on their behalf.

And so it goes with the federal student loan system.

Both the income-driven repayment plans that have existed for years and a special debt cancellation program for public servants are already poster children for administrative burdens. Tracking your progress is a part-time job, complete with self-help Facebook groups of frustrated debtors and companies to help people manage the process.

And wouldn’t you know it? There are several third parties to which the federal government has outsourced the work of collecting student loan payments and enforcing the rules.

would go to 5 percent from 10 percent of discretionary income; the amount of a person’s income that doesn’t meet the definition of discretionary would rise; and there would be a new, more generous way of calculating how balances shrink or grow over time. There are plenty of reasons to be skeptical that something this complex would roll out smoothly or quickly.

And it would not be cheap. Estimates from the Penn Wharton Budget Model put the 10-year cost of the new repayment plan at anywhere from $70.3 billion to over $450 billion, depending on the implementation details and how students and schools change their borrowing and tuition-setting behavior. Again, it’s complicated.

By comparison, Mr. Biden had proposed spending $45.5 billion over five years to make up to six semesters of community college free nationwide. That would have paid for most of the cost, with states contributing the rest. No debt for tuition, no hoops to jump through.

Politics got in the way of free community college, and the Inflation Reduction Act that Mr. Biden signed last month did not include it. Instead, students who borrow would get a subsidy on the back end through the more generous repayment program, years later, if they know it exists, enroll without incident, clear every hurdle over a decade or two and their loan servicer doesn’t make a hash of it.

There are bad words and associated acronyms that we could use to sum all of this up as we scream into the void. But our framing could just as easily center on a single word: Respect.

Professor Herd surprised me this week when she said the word in passing. I asked her to elaborate.

“Respect includes everything from respecting people’s time to not treating them as if they are trying to cheat or game a system,” she said. “It’s about treating them as if they are full-fledged citizens and human beings who have basic rights to access services and benefits for which they’re eligible.”

It seems simple enough. But too much of our personal finance infrastructure becomes adversarial through its complexity. The “prove it” nature of Mr. Biden’s executive action, with its income measurements and repeated checking in with third-party servicers, does not help, as generous as it may turn out to be for people who would eventually pass muster.

Disrespect is calling student debt cancellation “forgiveness” when it’s really an apology for a dysfunctional higher education financing system. Disrespect is doing little to make tuition cheaper on the front end of this process. Disrespect is letting many for-profit schools continue to put people of color deep into debt for certificates or degrees that don’t mean much in the labor market.

Disrespect guarantees full-time employment for personal finance journalists, too. I’m lucky to have the work, but it shouldn’t be necessary in the first place.

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Planning for Your Retirement, and for a Child’s Special Needs, All at Once

Rachel Nagler, 39, has worked part time since she was 22, but she will never be financially independent, according to her father. She is legally blind with a seizure disorder and mild cognitive impairment, the result of birth trauma.

For her parents, Sam and Debra Nagler of Concord, Mass., planning for retirement required them to focus on Rachel’s future as well as their own.

“She has very limited earning capacity,” Mr. Nagler, 70, said. “The concern is, is this sufficient for her for the rest of her life?”

His wife, who is 68, has been their daughter’s primary caregiver since her birth.

“Nobody knows Rachel, and takes care of Rachel, and knows every need of Rachel, and is on top of everything other than my wife,” Mr. Nagler said. “That’s a worry because she’s not going to live forever.”

For parents of children who have serious disabilities or special needs, the challenges of growing and preserving their wealth are magnified exponentially, and the stakes are much higher. While they are trying to plan for their own retirements, these parents need to simultaneously secure the ‌ stability of a son or daughter who will be dependent on them‌ until — and even after — their deaths.

“We want to make 100 percent sure that after we’re gone, there’s no issue,” Mr. Nagler said.

Under the best of circumstances, caring for an adult child with special needs is physically and emotionally taxing. As these parents age, the question of who will house, feed and drive their son or daughter after they no longer can becomes an urgent one.

But not all parents in this situation are aware of the myriad challenges they face. “Getting them to understand that they need to think differently about their retirement in this scheme of things is a key step. And it’s not simple,” said Mary Anne Ehlert, a certified financial planner and founder of Protected Tomorrows, a financial planning firm that specializes in families with special needs.

For example, Ms. Ehlert said, she has to consider a multigenerational time horizon for these clients’ portfolios. “We might be a little more conservative, but we still need growth. We need growth longer,” she said. But a conservative-leaning asset mix has drawbacks, too. “Conservative doesn’t always give us the growth we need,” she said. In addition, many families opt for a portion of their portfolio to be in cash or cash-like liquid investments in the event that their child suddenly needs a new piece of expensive equipment, like a speech-assistive device.

Often, one spouse will sideline a career or leave the work force entirely to provide care, reducing their own ability to save for retirement. These families find their budgets strained by a host of ancillary costs: paying for gas to drive their children to therapy appointments and day programs; buying supplies like adult diapers and waterproof bedding, compression tights to promote circulation, specialized diets — the list goes on.

Even when the disabled individual qualifies for public health assistance, finding affordable, adequate housing is especially difficult. Some people require supervised care in a group home, while others need in-home care in a dwelling modified to accommodate physical limitations. In both cases, waiting-list times are measured in years.

As a result, many parents feel they have no choice but to keep their son or daughter at home, said Harry Margolis, an estate planning lawyer near Boston who works with families with special needs. “Often, they’re still living with parents even when everybody’s getting older,” he said.

This can be expensive in terms of lost opportunity costs. To spare their child the upheaval, parents might forgo the opportunity to downsize into a less-expensive or more accessible home while they are still healthy enough to do so.

Since most of the public benefits available to special-needs and disabled people are administered at the state level through Medicaid, parents of a special-needs child might not be able to move to a state with a lower cost of living. Doing so could mean the adult child would lose access to their benefits and be placed at the bottom of waiting lists for services in a new state.

Some families, however, move to states that offer more generous benefits, even if it means a higher cost of living. “That’s a real struggle for these families, particularly as Mom and Dad age,” said Debra Taylor, founder of Taylor Financial Group in Franklin Lakes, N.J. “Some look to relocate to different states because some states are more hospitable than others.”

Douglas and Susan Rohrman moved out of the Chicago area five years ago, alarmed at the declining health of their daughter Liz, who suffered a traumatic brain injury just before the age of 2. Now, 38, the younger Ms. Rohrman has a host of physical challenges, including partial paralysis that impairs her mobility and ability to swallow and cognitive impairment.

“Liz was not getting great care in Illinois, so it was time to sell the house and move everything,” Ms. Rohrman, 74, said. “I researched this up the wazoo.”

The Rohrmans moved to the San Diego area because resources such as housing and day programs were more readily available. But when Covid struck, the couple felt that the only way they could keep their daughter safe — she had been hospitalized with pneumonia three times in 2019 — was to take her out of the care home they had moved her into just a few years earlier, the one they’d uprooted their lives for.

It was an enormous adjustment in responsibilities, but also in finances.

“When we were doing our taxes, I sort of sat down to see where my money was going. And Liz is a large part of it,” Ms. Rohrman said, ticking off items for which she has to pay out of pocket now that her daughter is living at home.

For example, swallowing difficulties mean that the younger Ms. Rohrman has to have a thickening agent added to her water. That alone costs several thousand dollars a year, her mother said, and there are a host of other unique expenses, such as for stabilizing footwear that helps her daughter walk. “I came up with like $9,000, not counting everything I buy at the grocery store and Walmart,” she said.

Mr. Rohrman, 80, had deferred his retirement at a law firm several years to keep earning income, but he stopped working when the family moved. The combination of much higher expenses, a drop in income and a flagging stock market demanded they re-evaluate their finances.

These financial struggles are magnified for single parents. “Care is inevitably more expensive when you have a single parent,” Ms. Taylor said, because they have to rely much more on paid caregivers.

Laura Weinberg, 59, became the sole caregiver for her son Will, who is autistic and nonverbal, when her husband, a lawyer for the Port Authority of New York and New Jersey, was killed in the Sept. 11 attacks.

“I was in the weird situation of being widowed when I was 38, dealing with a 4-year-old who was a danger to himself,” she said. She was also a caregiver for her ailing mother and maintaining the family home in northern New Jersey. “I was overwhelmed,” she said.

“Estate planning was confusing and extremely expensive when I started to put a toe in the water,” she said. “I got all kinds of wrong information.”

Ms. Weinberg said she would like to have speech-assistive equipment for her son so that he can communicate, but the cost is prohibitive. Instead, she has pieced together a solution with an iPad and specialized apps. “It’s more modest than it might have been, but some of them are in the many thousands of dollars,” she said.

For parents of special-needs children, retirement planning and estate planning have to take place in tandem. Special-needs trusts and life insurance policies in one or both parents’ names are two of the most commonly used tools. Both have to be structured in compliance with the complex eligibility regulations for public health benefits, since many are means-tested.

Mr. Margolis said that even wealthy families have to navigate the byzantine landscape of government benefits, because many of the services available, including housing, are administered entirely through these programs. “In order to qualify for S.S.I. and Medicaid, in most cases you’re limited to $2,000 in countable assets,” he said.

“For a disabled individual, a lot of time, maintaining eligibility is critical,” said Joellen Meckley, executive director of the American College of Financial Services’ center for special needs. “I can’t tell you how many times family members, with the best of intentions, will name a disabled adult child as a beneficiary, not understanding that getting that money could immediately jeopardize their ability to access public benefits,” she said, referring to parents’ wills, retirement plans or life insurance policies.

This makes it imperative that money intended for a disabled individual be held in a specialized financial instrument such as a special-needs trust.

The money in a trust can go toward quality-of-life enhancements for the special-needs individual like cable TV, a cellphone or computer, better food, care providers and rent or utilities, without jeopardizing their public benefits, Mr. Margolis said.

There are two main categories of special-needs trusts. First-party trusts are established with assets that belong to the individual. The drawback is that these trusts have a payback clause: After the individual dies, any money remaining in the trust goes to reimburse the state for the cost of their care over the years.

Third-party special needs trusts are established and funded by someone else for the benefit of the disabled individual. “A third-party one takes in the assets of other people, like gifts, inheritances or life insurance proceeds,” said Brian Walsh, senior manager of financial planning at SoFi.

These trusts are often funded or supplemented with parents’ life insurance proceeds. “A lot of times, life insurance can be used to kind of create a funding source when one or both of them passes away,” Mr. Walsh said.

A “second-to-die” life insurance policy is a frequently used tool. Both members of a couple are covered under it, and the policy pays out after the second spouse dies, providing a more affordable option than insuring each parent separately.

“The purpose of this policy is that it’s going to pay out a death benefit to fund the child’s remaining needs no matter when the parents die,” Mr. Walsh said.

Since the funds in these trusts are generally conservatively invested, experts say the final challenge is making sure that the amount in the trust will provide an adequate income stream.

Getting that balance right is something that the Rohrmans, in California, struggle with.

When Mr. Rohrman stopped working, that meant not only paring back household spending, but revisiting their investing strategy as well.

“We’re financially very conservative. We know we can’t be like we were in our 30s and 40s in terms of our investment mix, spending and so forth,” Mr. Rohrman said. “We think about it a lot. We don’t let it dominate us.”

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President Biden To Sign Executive Order Protecting Travel For Abortion

and Associated Press
August 3, 2022

The order will allow states who haven’t banned abortion to apply for Medicaid waivers to help them treat women who’ve traveled from out of state.

President Joe Biden on Wednesday will sign an executive order aimed in part at making it easier for women seeking abortions to travel between states to obtain access to the procedure.

More specifically, one of the directives the president will issue will allow states that have not outlawed abortion to apply for specific Medicaid waivers that would, in effect, help them treat women who have traveled from out of state.

The order will also call on health care providers to comply with federal nondiscrimination laws and streamline the collection of key data and information on maternal health at the National Institutes of Health and the Centers for Disease Control and Prevention. The details were described by senior administration officials who spoke on the condition of anonymity to discuss the executive order ahead of a formal announcement.

President Biden, who continues to isolate in the White House residence after a rebound case of COVID-19, will sign the executive order as he helps launch a federal task force on access to reproductive care, led by Vice President Kamala Harris, the officials said.

The new order nonetheless falls short of what many Democratic lawmakers and abortion advocacy groups have demanded of the Biden administration since the Supreme Court’s decision overturning the landmark 1973 ruling Roe vs. Wade. One chief ask has been for President Biden to declare a public health emergency on abortion, which White House officials have said would do little to free up federal resources or activate new legal authorities.

Wednesday’s order is the latest in a series of executive actions from the Biden administration since the constitutional right to an abortion was eliminated in Dobbs v. Jackson Women’s Health Organization in June.

Separately, on Tuesday, the Justice Department sued Idaho over its statute that criminalizes abortions, with Attorney General Merrick Garland arguing that it violates federal law.

Additional reporting by The Associated Press.

Source: newsy.com

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Biden Announces New Efforts To Address Youth Mental Health Crisis

The Biden administration also urged governors across the nation to invest more in school-based mental health services.

The White House has unveiled two new initiatives on mental health for the youth of America.

To address rising rates of depression, anxiety, and suicidal thoughts among young people, the Department of Education will start to distribute nearly $300 million next week to expand mental health services in schools.

Part of the money will be used to hire mental health professionals, school counselors, social workers, and other staff members specifically trained to help with the mental health needs of students in the U.S.

The Biden administration also urged governors across the nation to invest more in school-based mental health services.

“In a letter sent today to Governors across the country, the Departments of Education and Health and Human Services highlight federal resources available to states and schools to invest in mental health services for students. The joint letter from Secretaries Becerra and Cardona highlights actions by the Biden-Harris Administration to improve the delivery of health care in schools and make sure children enrolled in Medicaid have access to comprehensive health care services, as required by law,” the White House said in a press release.

There’s an additional $1.7 billion that will go to schools across the country towards mental health services as part of the Bipartisan Safer Communities Act (BSCA) signed by President Biden last month.

According to the CDC, more than 40% of teens say that they struggle with feelings of sadness or hopelessness.

Source: newsy.com

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Phony Diagnoses Hide High Rates of Drugging at Nursing Homes

The handwritten doctor’s order was just eight words long, but it solved a problem for Dundee Manor, a nursing home in rural South Carolina struggling to handle a new resident with severe dementia.

David Blakeney, 63, was restless and agitated. The home’s doctor wanted him on an antipsychotic medication called Haldol, a powerful sedative.

“Add Dx of schizophrenia for use of Haldol,” read the doctor’s order, using the medical shorthand for “diagnosis.”

But there was no evidence that Mr. Blakeney actually had schizophrenia.

Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.

one in 150 people.

Schizophrenia, which often causes delusions, hallucinations and dampened emotions, is almost always diagnosed before the age of 40.

“People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”

refuge of last resort for people with the disorder, after large psychiatric hospitals closed decades ago.

But unfounded diagnoses are also driving the increase. In May, a report by a federal oversight agency said nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition.

hide serious problems — like inadequate staffing and haphazard care — from government audits and inspectors.

One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are on antipsychotic medications.

According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia diagnoses.

To determine the full number of residents being drugged nationally and at specific homes, The Times obtained unfiltered data that was posted on another, little-known Medicare web page, as well as facility-by-facility data that a patient advocacy group got from Medicare via an open records request and shared with The Times.

The figures showed that at least 21 percent of nursing home residents — about 225,000 people — are on antipsychotics.

The Centers for Medicare and Medicaid Services, which oversees nursing homes, is “concerned about this practice as a way to circumvent the protections these regulations afford,” said Catherine Howden, a spokeswoman for the agency, which is known as C.M.S.

“It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” she said. “We will continue to identify facilities which do so and hold them accountable.”

significant drop since 2012 in the share of residents on the drugs.

But when residents with diagnoses like schizophrenia are included, the decline is less than half what the government and industry claim. And when the pandemic hit in 2020, the trend reversed and antipsychotic drug use increased.

For decades, nursing homes have been using drugs to control dementia patients. For nearly as long, there have been calls for reform.

In 1987, President Ronald Reagan signed a law banning the use of drugs that serve the interest of the nursing home or its staff, not the patient.

But the practice persisted. In the early 2000s, studies found that antipsychotic drugs like Seroquel, Zyprexa and Abilify made older people drowsy and more likely to fall. The drugs were also linked to heart problems in people with dementia. More than a dozen clinical trials concluded that the drugs nearly doubled the risk of death for older dementia patients.

11 percent from less than 7 percent, records show.

The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.

Caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression. But many nursing homes are chronically understaffed and do not pay enough to retain employees, especially the nursing assistants who provide the bulk of residents’ daily care.

Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs. That suggests that some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff. (Homes with staffing shortages are also the most likely to understate the number of residents on antipsychotics, according to the Times’s analysis of Medicare data.)

more than 200,000 since early last year and is at its lowest level since 1994.

As staffing dropped, the use of antipsychotics rose.

Even some of the country’s leading experts on elder care have been taken aback by the frequency of false diagnoses and the overuse of antipsychotics.

Barbara Coulter Edwards, a senior Medicaid official in the Obama administration, said she had discovered that her father was given an incorrect diagnosis of psychosis in the nursing home where he lived even though he had dementia.

“I just was shocked,” Ms. Edwards said. “And the first thing that flashed through my head was this covers a lot of ills for this nursing home if they want to give him drugs.”

Homes that violate the rules face few consequences.

In 2019 and 2021, Medicare said it planned to conduct targeted inspections to examine the issue of false schizophrenia diagnoses, but those plans were repeatedly put on hold because of the pandemic.

In an analysis of government inspection reports, The Times found about 5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications. Nursing home officials told inspectors that they were dispensing the powerful drugs to frail patients for reasons that ranged from “health maintenance” to efforts to deal with residents who were “whining” or “asking for help.”

a state inspector cited Hialeah Shores for giving a false schizophrenia diagnosis to a woman. She was so heavily dosed with antipsychotics that the inspector was unable to rouse her on three consecutive days.

There was no evidence that the woman had been experiencing the delusions common in people with schizophrenia, the inspector found. Instead, staff at the nursing home said she had been “resistive and noncooperative with care.”

Dr. Jonathan Evans, a medical director for nursing homes in Virginia who reviewed the inspector’s findings for The Times, described the woman’s fear and resistance as “classic dementia behavior.”

“This wasn’t five-star care,” said Dr. Evans, who previously was president of a group that represents medical staff in nursing homes. He said he was alarmed that the inspector had decided the violation caused only “minimal harm or potential for harm” to the patient, despite her heavy sedation. As a result, he said, “there’s nothing about this that would deter this facility from doing this again.”

Representatives of Hialeah Shores declined to comment.

Seven of the 52 homes on the inspector general’s list were owned by a large Texas company, Daybreak Venture. At four of those homes, the official rate of antipsychotic drug use for long-term residents was zero, while the actual rate was much higher, according to the Times analysis comparing official C.M.S. figures with unpublished data obtained by the California advocacy group.

make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.

But prescriptions of Depakote and similar anti-seizure drugs have accelerated since the government started publicly reporting nursing homes’ use of antipsychotics.

Between 2015 and 2018, the most recent data available, the use of anti-seizure drugs rose 15 percent in nursing home residents with dementia, according to an analysis of Medicare insurance claims that researchers at the University of Michigan prepared for The Times.

in a “sprinkle” form that makes it easy to slip into food undetected.

“It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.

In the early 2000s, Depakote’s manufacturer, Abbott Laboratories, began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as “chemical restraints,” according to a federal whistle-blower lawsuit filed by a former Abbott saleswoman.

According to the lawsuit, Abbott’s representatives told pharmacists and nurses that Depakote would “fly under the radar screen” of federal regulations.

Abbott settled the lawsuit in 2012, agreeing to pay the government $1.5 billion to resolve allegations that it had improperly marketed the drugs, including to nursing homes.

Nursing homes are required to report to federal regulators how many of their patients take a wide variety of psychotropic drugs — not just antipsychotics but also anti-anxiety medications, antidepressants and sleeping pills. But homes do not have to report Depakote or similar drugs to the federal government.

“It is like an arrow pointing to that class of medications, like ‘Use us, use us!’” Dr. Maust said. “No one is keeping track of this.”

published a brochure titled “Nursing Homes: Times have changed.”

“Nursing homes have replaced restraints and antipsychotic medications with robust activity programs, religious services, social workers and resident councils so that residents can be mentally, physically and socially engaged,” the colorful two-page leaflet boasted.

Last year, though, the industry teamed up with drug companies and others to push Congress and federal regulators to broaden the list of conditions under which antipsychotics don’t need to be publicly disclosed.

“There is specific and compelling evidence that psychotropics are underutilized in treating dementia and it is time for C.M.S. to re-evaluate its regulations,” wrote Jim Scott, the chairman of the Alliance for Aging Research, which is coordinating the campaign.

The lobbying was financed by drug companies including Avanir Pharmaceuticals and Acadia Pharmaceuticals. Both have tried — and so far failed — to get their drugs approved for treating patients with dementia. (In 2019, Avanir agreed to pay $108 million to settle charges that it had inappropriately marketed its drug for use in dementia patients in nursing homes.)

Ms. Blakeney said that only after hiring a lawyer to sue Dundee Manor for her husband’s death did she learn he had been on Haldol and other powerful drugs. (Dundee Manor has denied Ms. Blakeney’s claims in court filings.)

During her visits, though, Ms. Blakeney noticed that many residents were sleeping most of the time. A pair of women, in particular, always caught her attention. “There were two of them, laying in the same room, like they were dead,” she said.

In his first few months at Dundee Manor, Mr. Blakeney was in and out of the hospital, for bedsores, pneumonia and dehydration. During one hospital visit in December, a doctor noted that Mr. Blakeney was unable to communicate and could no longer walk.

“Hold the patient’s Ambien, trazodone and Zyprexa because of his mental status changes,” the doctor wrote. “Hold his Haldol.”

Mr. Blakeney continued to be prescribed the drugs after he returned to Dundee Manor. By April 2017, the bedsore on his right heel — a result, in part, of his rarely getting out of bed or his wheelchair — required the foot to be amputated.

In June, after weeks of fruitless searching for another nursing home, Ms. Blakeney found one and transferred him there. Later that month, he died.

“I tried to get him out — I tried and tried and tried,” his wife said. “But when I did get him out, it was too late.”

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