6000 words/20 minute read w/links

By M. Jane Letty 

It was the Year of the Snake when I was living in The Netherlands. One morning, while listening to the raindrops ticking at the window mitigate, I decided to get dressed and catch a train to Rotterdam for the day. After a long walk along the worn cobble-lined streets, in and out of bookstores, art galleries, floral shops along the canal, I’d wandered a little farther than I realized. It’s true, the road less travelled leads to enlightenment. 

Sometimes, as in this case, it would take twenty years to arrive. 

The aromas of (still) the best coffee I’ve ever had and one of my favorite dishes, Thai Peanut Chicken, with its perfectly balanced nutty sweet and pungent heat lured me into a sidewalk coffeehouse. Arriving at the same time, was the handsome part of a metro-beautiful couple who opened the door for me. “Dank je wel.” I said, smiling as I floated in. Dining alone had become a newfound pleasure of mine where I could read or write, or people watch in peace and no pressure for engaging conversation. Listening, too, is an art. Any one of them, a perfect blind date for a lost soul in search of itself.

Nonetheless, a delightful conversation ensued with the same couple now seated next to me. Since I spoke little Dutch, they were kind enough to help me place my order. We laughed about how my being misguided by the scent of Thai Peanut Chicken gave me away after a perfectly delivered “thank you” at the door, but correct about the coffee.  After enjoying a token compliment over tiny cups of coffee, they extended an impromptu invitation to be a third wheel for the 2001 Chinese New Year celebration nearby. I was a stranger in a strange land, flying solo, and graciously accepted. 

The sound of the merriments travelled the blocks away we were from before we turned the corner. Once there, the diverse mix of locals and other tourists enveloped us, amid a rippling sea of gilt-vector sinography on red silk draping the pristine and brightly lit storefronts flanked by Spring couplets invoking prosperity; beating drums of hide and metal, keeping time with the bamboo flutes delicately landing along notes on looping scales of nine and twelve like a game of hopscotch; glowing red paper lanterns with tassels dangled along the Paifang

Although this Chinatown’s version was remarkable, it wasn’t too different from those I’d attended in Philadelphia. I was so sure it would be. Still, I was not disappointed. Or, maybe everything was different and a little better after a cup of Rotterdam’s coffee

Nostalgia dictates a recalling of a strangely thick combination of the aerosolized scents of fabric starch released by the elaborately costumed dancing lions, whiffs of freshly cut flowers showing off their pops of color in ornate porcelain vases, plumes of spent gunpower from firecrackers liberated from their muted-red casings scattered along the sidewalks, authentic Chinese foods—the Thai Peanut Chicken—and the transmittable excitement. The familiarity of the unintentionally impolite shove and bumpery of people in a hurry to get somewhere or nowhere was much like NYC at any hour. Stopping for a moment, the bustle swallowed me whole. I was admiring the artfully painted paper dragons bouncing on sticks held by leaders to follow them. That’s where I’d lost sight of my hosts-by-acquaintance. Fortunately, the crush carried me to the front-row of the roped-off section for the main attraction. I was enchanted by the costume’s elaborate detail and flickering mechanisms pairing with the choreography. Two men underneath were stomping about like playful lions, eagerly anticipating the customary offering of a shredded cabbage placed in its mouth by the proprietor. 

That’s when I saw it. 

Had I blinked, I might’ve missed seeing the sleight of hand mechanism behind decades of corruption, respectively, Chinese New Year and US nursing homes have in common—perfected.

Did you see it, too? 

If not, that’s okay. You will…I promise

What these two completely unrelated cultures have in common, that would overlap, I would later learn no matter where I worked as a nurse. I’m retired, now. However, I was a writer while living abroad and before I became a nurse. The two professions share a similar appreciation of subtle details. Nurses constantly assess their patients for signs to get ahead of potential complications. Same is true for us writers with the walk-abouts, looking for out of sequence events, crouching tigers, saving them for later as story-seeds. 

It is now the Year of the Rat. Twenty years later. I’d returned to New Jersey shortly after what I saw during my time abroad. It haunted me, what I saw, but I didn’t know why until a few year’s later…and for a few year’s after. To offset the contempt I had for the process and the dis-ease it caused, I mocked it for being suspicious enough to be wrong, but standard practice enough to fly under the radar. 

Then, it all came together and all at once. 

One morning, while listening to the drip…drip…drip of Governor Andrew Cuomo, (D-NY) torture anyone interested in pertinent updates on how New York’s Democrat leadership was mangling their response to the second worst event to happen to them since 9/11—enlightenment arrived. 

It was a not-so-cheap(shot), Made in China virus-import that had infected the entire world. Elected officials had allowed NY to get hit exceptionally hard. It’s sad to see, really. Their leadership did the people of NY no favors when it mattered most. Made all the worse by their ignorance and arrogance, further complicated by their hatred of all-things President Trump—at the expense of their own constituents and beyond. (Even my own governor, Phil Murphy, whom I am not a fan of, would later temporarily set aside politics in the interest of my fellow New Jerseyans, asking only for pandemic-related funding assistance, not legacy budget woes. All other things Governor Murphy I ideologically reject, but especially his failure to protect NJ’s senior citizens and Veterans targeted, and once again forgotten, from the ravaging effects of COVID-19.) 

“The order was horrifying, but not unusual. A number of blue states, including New York and California, had issued similar orders. But New Jersey had nearly half its deaths occur in nursing homes. Horrifying scenes, such as 18 bodies stacked in one nursing home facility waiting for pickup or the 53 veterans who died at the New Jersey Veterans Memorial Home in Paramus, would soon fill the news.

As of now, 16,000 deaths have happened in nursing homes nationwide. That’s 1 in 4.”   ~ Daniel Greenfield, for Frontpage Mag 

I’ve worked as a nurse, (full-time and agency) in many for-profit long-term care facilities, exclusively nightshift. It’s the shift you worked if you wanted to avoid workplace politics, which I did. But a selective ignorance about government politics is costly when the issues that matter most fail to perform. There’s a punishing price to pay. This time, for their contributions to society, our senior citizen population would pay twice as much, twice as hard, with their very livesfor the wide-spread ignorance of many and the rapacious arrogance of a powerful few. 

The Baby Boomer and Silent Generation, hospitalized or warehoused in many of Cuomo’s state-regulated nursing homes, were cruelly designated of no significance or consequence, politically, to him in four damning words: “…it’s not our job.” 

Yet, was it New York Governor Andrew Cuomo’s job to announce a protective order for people over 70 honoring his own mother, Matilda Cuomo, to officially remind all citizens to think of their mothers to abide by the restrictions? 

Maybe if that job is being a ghoul. To justify his sadistic braggadocio, he deflected those facilities are for-profit as if to say New York doesn’t profit from nursing homes. It does profit through property and payroll taxes, and, one other way. It’s not exactly profit, but the state does benefit…bigly.

Cuomo also seems pretty stoked about the possibility of Robert “F-Trump” Di Nero in an upcoming movie about his role during the pandemic. An aside to the absurdity, while people are sick and/or dying, lives and livelihoods are in jeopardy, children are bewildered, economy is brittle, our social norms are fractured, yet those who’ve failed us the most are glib about how to exploit our pain by making a movie about it. 

But, I digress.  

As a coping mechanism, many seniors may seek the sanctuary of long-term memories as a way of dealing with the stress being imposed on them. The psychological impact on our senior citizens, the most affected generation of this pandemic, is of significant burden to them for a multitude of reasons. Among them, invoking stories about what happened to their own parent’s and grandparent’s, and anxiety over how the stories of what happened to them will be told to, and affect, their grandchildren

“ In WWI, Germany released 5,730 cylinders of chlorine gas across a four-mile stretch of no-man’s-land into the Allied lines during the Second Battle of Ypres in April, 1915. Thus the birth of chemical warfare. Britain replied in kind, releasing cylinders of chlorine gas during the Battle of Loos the following summer, and  Germany upped the horror in July, 1917, delivering artillery shells filled with dichlor-ethyl-sulphide or “mustard gas” just prior to the Third Battle of Ypres.

Chlorine gas attacked the airways. Severe respiratory swelling and inflammation killed many instantly and the rest struggled to nearby casualty clearing stations with acute congestion of the lungs, pneumonia, and blindness. Soldiers who had inhaled the most gas arrived with heavy discharge of a frothy yellow fluid from their noses and mouths as they drowned in their own secretions. For the rest, partial suffocation persisted for days, and long-term survivors had permanent lung damage, chronic bronchitis, and occasionally heart failure. Mustard gas burned the skin and respiratory tract, stripping the mucous membrane off the bronchial tubes and causing violent inflammation of the eyes.  Victims were left in excruciating pain and utterly helpless.” Paul E. Stepansky, Ph.D.

“Vietnam was and always will be their war, just as World War II belonged to their parents, and World War I to their grandparents. The war stories of older generations—stories about mustard gas, Guadalcanal, or the liberation of little French towns—have little meaning for those who came of age during Vietnam.”

~ Lawrence M. Baskir and William A. Strauss/The Walking Wounded (1978)

We can only hope this catastrophic, completely avoidable outcome, is an epiphany for those who failed our senior citizens to do the right thing and resign their positions in shame. Nonetheless, neither the nursing home administrator’s or elected official’s past failings of how they dismissed and neglected decades of poor quality and inadequate staffing before this health crisis—or Cuomo’s ghoulish delight of a starring role in a story that isn’t his to tell—is not what this essay is about.

It’s about something else. 

Something worse if you can imagine…

Let’s get after it, shall we? 

Once a year, without fail, two things happen at every for-profit nursing home: Corporate visit and State Survey. Both events are red carpet-style spectacles. Corporate gives advance notice, while the State Survey gives none. Occasionally, a neighboring facility hits the silent alarm and faxes over a hit list of violations the state is targeting. Otherwise, it’s a spot inspection. Or, as I’m about to reveal, a mafia-style shakedown. No one does mafia-style shakedown’s like NYC. 

No one.

Except, maybe…China.  

Do you see it, now? 

We’re getting closer.

The last time I was on-duty during a State Survey at a nursing home was not long after Obamacare was imposed. Disgusted and burned out, I moved on to correctional nursing, where I learned the spirit-crushing reality that prisoners have a right to demand better healthcare than our far more-deserving elderly under the Eighth Amendment of the US Constitution. 

I expect some may wince at that remark. To clarify, I’m not saying prisoners deserve less care; only that they have a constitutional right to demand better care—and they get it on demand or they call their public defense attorney and sue the medical provider and the jail or prison. I know this, having won a CEPA whistleblower settlement based on 8A violations with respect to wide-spread CMS fraud committed by government contractors, institutions, and public defenders—also at taxpayer expense. 

Unlike senior citizens in nursing homes who get what they get and if they don’t like it, they don’t have a constitutional right they can assert or a lawyer who’s paid by the taxpayer to sue the facility—and most facilities have a disclaimer requiring arbitration hearings that take longer to be heard than some patients have to live.

Prisoners have a right under the Eighth Amendment to receive adequate health care during their incarceration. The prison population, however, possesses significantly poorer health than the general population. Because disease does not discriminate, the effects of prisoners’ poor health extend beyond prison walls. ~ Prison Fellowship

Many nursing home and hospice residents are elderly, frail or have cognitive difficulties. Often, they fit all three categories. Buried in Genesis Healthcare nursing home and hospice contracts was a clause that says patients cannot sue if they are injured or killed by poor care. Instead, any claims must be submitted to arbitration with no jury and with strict secrecy provisions.” (Elite Lawyer Management, 09/03/2017)

For either occasion, Administrator’s summon the stage-setters: over-night janitors are called in to polish the previously dull floors beyond the reception lobby, housekeeping to wash windows and buff chrome fixtures, maintenance workers to make long-requested repairs, landscapers to trim the dead away from shrubs and plant pops of aesthetic color, and for a few weeks, the facility looks every bit as nice as the lobby—as it should, but it doesn’t. A florist delivers a welcoming bouquet of fresh flowers, in a pretty-but-plastic vase of course, for the reception desk and sprays of floral arrangements grace the nurses stations. The activities department places silk flower centerpieces atop clean, crisp linens draping the tables in the main dining room, and everything looks and smells and feels like a place one might find those precious waning years, golden

To be fair, not every nursing home is as morose as the one I’m describing. There are some that do their best to provide care and work very hard, even some that look less like corporate atriums and more like…home. But, it should disturb us all to know far too few homes for our senior citizens are authentically well-kept, well-run, fully staffed, and don’t need a corporate visit or state survey for a reason to dress to impress. 

For-profit nursing homes are exactly that, for profit. The established problem is the CMS funding they get isn’t always applied where it’s intended or needed most—patient care through investing more on adequate and quality staffing and less on upper management salaries and a fancy reception lobby. 

After the nursing home has been spruced up and the facility that warned us State Survey Teams wrapped up, it’s our turn on the rack: They usually arrive at 5 a.m. To access most facilities at that hour requires a Supervisor to unlock the door for the State’s dispatched survey team to cross the threshold and enter. While they wait under the archway, the delicious aromas of sausage or bacon and real eggs or pancakes, and coffee—the good kind—surrounds them. The team leader tapes to each side of the glass double doors a sign, at eye-level, on hot-pink paper to notify visitors the annual state survey was in progress. 

Most of these survey’s last about a week and conclude with must less fanfare. A meeting is then called by management to review with staff what violations the facility can expect to be cited and what they expected us to do to correct them. Some staff get written up, other’s a verbal reprimand. The shift supervisors hold in-services, specific to the citations, everyone was mandated to participate. Usually, it’s just to sign a paper that would be used to prove to the State we were educated. After a few years, I started to realize the citations had a reoccurring theme, which I later learned, were the same violations as the year before…and year’s before. Like ordering the same thing every visit from a local Chinese take-out menu. 

I, however, was on the inside: viewing from a perspective many inspectors do not get to see. When nursing homes are surprised with an inspection, somehow understaffing is no longer an issue. On these occasions, the administration calls in all PRN nurses and many off duty nurses in order to possess a full staff. For these few short days, the issues associated with understaffing are resolved, but the rest of the year these issues continue just as strongly as ever. Even if these issues are discovered, state inspectors usually just warrant a fine to the nursing home. 

Many nurses become discouraged because “not only are these nurses faced with the dissatisfaction of not being able to properly care for the residents, they also must bear the heavy burden of knowing that they may be held personally liable when they walk into work and realize that they are one of too few employees working their shift” (Miranda, 2005). In a working environment like this one, sufficient workers are a must, but the facilities are unable to provide for their employees, which ultimately harms the residents

~ By Maura Fisher for Artifacts/ A Journal of Undergraduate Writing

My co-nurse arrived shortly after me for that shift. She misread the unusual preening of our normally dismal unit, now pristine and brightly lit, amid a sea of floral scrub tops worn by the added, (agency) staff on the assignment sheet.  

“Is Corporate coming?”, she asked as she set down her coffee and bookbag behind the nurses’ station.  

Mockingly, I announced, waving a little piece of paper, “Nope. It’s Chinese New Year!” I returned to checking my medcart, per the Supervisor’s hit-list to prepare it for pre-Survey inspection. 

After years of watching this annual event, it was my code for State Survey Teams making their rounds. That shift functioned the best it had all a year, after our shift assisted into the comfort of their $600-$800 per day beds, all the sleepy-eyed patient’s that were sitting in the dayroom, (to make sure they were not disturbed—or disruptive—during survey) when we arrived; a.m. med pass ran on time; no one fell; no one was left lying in urine-soaked briefs until one of only two CNAs or a Nurse could respond to their call light; everyone who was scheduled for a bi-weekly shower was showered; snacks were provided; and, for that one night, everything was as it should always be—every night. 

On our way to clock-out—on time—the staffing coordinator stepped in our path and aggressively bartered with us to work the open shifts through the survey in exchange for time off after they left. Implying, if we didn’t, she would remember. We still declined. After our tours, we always went to the local coffee shop to kvetch about management or brag about our families. After ordering our over-roasted coffees, standing there in our scrubs, the barista asked us if we were nurses. Ever the affable one, my wing-nurse gave me a shot with her elbow and cheerfully replied, “Yes, we are!” 

Taking our seats, she asked me why I called State Survey Chinese New Year. I wanted to be careful how I told her. She wasn’t broken by what an industry nursing had become, and she had at least as many years ahead of her in the field as I had behind me. Our facility had the lion’s share of Vietnam War Veterans. Without hesitation, and with the confidence of knowing they would help her forge ahead in our Obamacare War, given the metaphoric parallels of The Bush and what us nurses call The Weeds. I wanted to tell her the truth, but not in a way that might disconnect her calling.

The Bush

“If you were a Grunt or an artillery forward observer or just unlucky, you humped the Bush. The “Bush,” had many forms, variations and aspects. The Bush stays with you always. A sight, smell, sound or sense can bring the personal images from the internal vault file to be reviewed, reminded and re-posted but never forgotten.

The Bush is incredible boredom, huge adrenalin rush, exaltation, exhaustion. Loneliness. The Bush is the Bush.

The Bush is always waiting. It has different times. Different faces. Different places. Always the same.

The Bush is not seeing enough.

The Bush is seeing too much.

The Bush is ugly and beautiful at the same time.

The Bush is what sticks in your mind when you take your last extraction ride.

The Bush is forever.”  ~ Fred Childs for Charlie Company

Since my coffee was bitter enough, I began to tell her of the great excitement and preparation I witnessed; the Chinatown storefronts, pristine and brightly lit, as was our facility’s grounds and entrance; the eminence of the Paifang, no different from facility archways; red Spring couplets invoking the same favor as the fluorescent-pink State Survey in progress notices flanking the doors; describing the welcoming sight of flowers in pretty vases; the comforting, appealing aromas of delicious food—the good kind; comparing the bustling crush of the crowd to the increased nurse to patient ratio; likening the painted paper dragon’s bouncing lead to our Supervisor unlocking the doors for the survey team; and, finally, the dancing lions crossing over the threshold for their…token exchange for protection

Every member of the State Survey Team is Made, or an Associate tags along as trainees for the survey, making their bones, sent to visit the nursing homes by the Regulatory Mafia, having sworn to the Oath of Obamacare. The citations for looping variations of the same nine or twelve or more violations. Some are small enough, going unnoticed by audit or large enough to add up to a steady revenue collected per facility that can be dipped into without too many questions, or not at all depending on the policy at arms.  

That’s when she saw it…too. 

I searched her astonished expression when I told her what I saw. And with her rapt attention, I nervously laughed, because I felt every bit the rat Joe Velachi or like a Bull in a China shoppe breaking every one of the 5 Simple Rules just by telling the story.

As a Made Man you must follow 5 simple rules, these rules are as follows:

1. Be loyal to members of the organization. Do not interfere with each other’s interest. Do not be an informer.

2. Be rational. Be a member of the team. Don’t engage in battle if you can’t win. The directive extends to personal life.

3. Be a man of honor. Respect womanhood and your elders.

4. Be a stand-up guy. Keep your eyes and ears open and your mouth shut. Don’t sell out.The ‘stand-up guy’ shows courage and ‘heart.’ He does not whine or complain in the face of adversity, including punishment, because ‘If you can’t pay, don’t play.’

5. Have class. Be independent. Know your way around the world. 

                                                                                               ~ National Crime Syndicate 

Just as it was then, it is now. At present, there are approximately 15,640 nursing homes in the US. If the average per violation fine is between $6,087 (PR) and $120,277 (MD) and the total sum averages between $28,761 (NH) and $11,462,556 (PA), that’s a pretty tidy sum, no? A total number of deficiencies cited at each facility and their corresponding take is an obnoxious tolling one can’t refuse. There’s a penalty if you do. 

President Trump’s moratorium on collection of these penalties wreaked havoc on many state budgets. Some, like NY, NJ, PA, were left scrambling to make up for the loss of revenue. Just as with any fine from any regulating body, that money doesn’t go to the victims—it goes to that government’s treasury for appropriation.

When I heard something alarming and telling in the tone of Governor Andrew Cuomo’s voice during one of his daily briefings, it all fit neatly. Not quite Joe Pesci in Goodfellas, the scene where the character takes offense at being questioned, but it was enough for me to make the connection. An escalating panic telegraphing a fever-pitch when he publicly threatened not only New York’s nursing homes, but every nursing home in the nation, (if they’re also working this racket): “You’ll be out of business if you’re not providing your staff with the right equipment. You’re out of business. That we can do,” he said of for-profit nursing homes under the revenue generating state regulations. All of his maneuvering and angling, hand wringing and ranting about the 6.7-billion-dollar hole he couldn’t fill because, “Revenues just stopped.” Cuomo has shown on more than one occasion, if he owns you, you owe him. In that threat he was busting them at the knees. All those years of tolerating the survey team visits and kowtowing to them to reduce the number of citations and paying the penalties to come down to this, a threat that if they don’t stop complaining to the media or demanding emergency PPE assistance or refusing to admit post/infected patients, he had the power to put them out of business. 

According to an enlightening NPRarticle and chart, “Federal records show that the average fine dropped to $28,405 under the current administration, down from $41,260 in 2016, President Obama’s final year in office.” However, the NPR article doesn’t mention the average fine is per facility. President Trump did slash the way fines and penalties were assessed, removing the excessive nature of them…by half. That’s a lot of state revenue lost.

In New York, they referred to Silver and Skelos as part of the “three men in a room” that cut the major deals in state politics, with Gov. Andrew Cuomo being the third. 

Joseph Percoco, a top aide to the governor, and Alain Kalayeros, a former university president entrusted by Cuomo to oversee his signature economic development programs, were both convicted last year as well. 

Notably, New York did not rely on the racketeering statutes to make its cases,…  

                                                                              ~  Mark Brown (November 29, 2019)

Also, according to the same NPR article, “Since President Trump took office, the administration has heeded complaints from the nursing home industry about zealous oversight. It granted facilities an 18-month moratorium from being penalized for violating eight new health and safety rules. It also revoked an Obama-era rule barring the facilities from pre-emptively requiring residents to submit to arbitration to settle disputes rather than go to court.” 

Translated, specific to NY, Cuomo’s meltdowns and thrashing of the nursing homes goes much deeper than and long before the pandemic. Many of those same facilities that found themselves in trouble when the pandemic hit, had a moratorium from paying penalties. In Cuomo’s estimation, these for-profit nursing homes had not been paying their dues since March 2019 and didn’t have to under that moratorium for another six-months at the height of this ordeal. Likely, they won’t have money for fines for the upcoming budget projections going forward. 

What incentive left was there to help these for-profit nursing homes for Cuomo? 

None. Absolutely none.  

But, it gets worse when you consider a nursing home patient is transferred out to hospital and treated or deceased related under a COVID-19 diagnosis billing code, many requiring ventilator treatment, there’s a significant increase in fees charged, (see chart below). When a nursing home patient is readmitted to a for-profit facility—especially requiring skilled nursing care—there’s a significant increase in new fees charged and paid in full through Medicare. It’s treated as a new patient.

Cuomo found a way to make up for his budget losses, at least in part. 

And, not be insensitive to those who lost loved ones, but if while in hospital as much was done for them as could be, there was someone else who could occupy that bed that would provide both the hospital and the for-profit facility new money—whether or not they survived, there’s a 20% add-on reimbursement through CARES Act 1. As far as Cuomo was concerned, a term loosely applied, he’s generating revenue with sand in his fists and the reimbursement trains running every 20 days. One of the reasons, I suspect, he didn’t send them to the USNS Comfort, Javitz Center, or Samaritan’s Purse is money and the discovery not all patient’s that were hospitalized, (and billed) under a COVID-19 diagnosis were actually infected with the virus or some other identifiers wouldn’t match. 

That’s fraud. 

Big fraud on possibly a RICO scale. 

“The first 20 days in the facility will be paid for in full by Medicare and days 21-100 will be subject to a co-pay, which can be covered by supplemental Medicare insurance (i.e. Medigap coverage) or other private health insurance.  If the individual is no longer progressing and/or maintaining their skill level with therapy or rehabilitation, their Medicare coverage will end and another payment source will be required.” 

                                                                               ~ Genser Dubow Genser & Cona LLP

To truly appreciate the token exchange for protection program, to which I’m referring, there’s a breakdown of every nursing home in the nation offering a total of deficiencies, fines, etc., and the option of viewing a single state’s amounts they owe. Those fines/penalties are just revenue that become appropriations, which they use to fill holes in their budgets. Governor Cuomo’s not the only one in government to rob Peter to pay Paul. It happens all the time, but state’s like NY, NJ, IL, CA seem to be struggling, significantly, during this pandemic by comparison to other states, which NY appears to have no idea other states are also in an economic shock of their own. 

But, NY unusually so.  

There’s an incentive to fine/penalize nursing homes. Not only to fill coffers, but also possibly coffins

For deaths after January 1, 2020, New York taxes estates of more than $5,850,000, which means that even if your estate isn’t large enough to owe federal estate tax (which currently exempts estates up to $11.58 million in value), it may still owe an estate tax to the State of New York. 

By law, a licensed funeral director must oversee the final disposition of a body in New York. For example, local registrars will only issue a burial or removal permit to a “funeral director or undertaker.” (See New York Public Health Law § 4140 (2018).)

You must arrange cremation through a funeral director, who will obtain the required permits. If the crematory does not have a licensed funeral director on its staff, you must arrange for a funeral director to be present to receive the body when it is delivered. (New York Public Health Law § 4145 (2018).) ~ NOLO

Joseph Antioco, funeral director at Schafer Funeral Home: “They are putting COVID on a lot of death certificates because people who are going to their hospital or any kind of respiratory distress, respiratory problems, pneumonia, the flu — the flu-like symptoms lead into the COVID-19. So, you know, it’s hard for them to put their finger on it … To me, all you’re doing is padding the statistics. You’re putting people on that have COVID-19 even if they didn’t have it. You’re making the death rate for New York City a lot higher than it should be …” ~  Hank Berrien for The Daily Wire

Funding Medicaid and hospitals

Cuomo in January was looking to trim $2.5 billion of the state’s $6 billion budget gap by cutting spending for Medicaid, the health insurance for the poor and disabled in New York that is used by about 20% of the state’s population and has ballooned to more than $60 billion a year.

But now that task is more complicated as more New Yorkers head to Medicaid because of job losses and as hospitals struggle to keep up with the influx of coronavirus patients.

Moreoever, Cuomo wanted to make counties, including New York City, pay for any Medicaid cost increases that exceed 3% each year.

Yet Congress passed a package earlier this month that linked $6.7 billion in federal aid for Medicaid to not moving costs onto local governments in New York — a deal Cuomo has refused to take. ~ By Joseph Spector / Gannett New York / Times Telegram

A common definition for the idiom, “in the red” means losing money, no money, or overdrawing your account at the bank and is thought to come from the feelings of stress and anxiousness and the physical symptoms they cause such as elevated blood pressure and often anger or danger. New York’s budget is in fiscal distress, desaturating money at an alarming rate before this happened. Cuomo believes those who left NY for low/no tax states like Florida, betrayed him—personally—referring to them as having “moved to die.” Cuomo also believes the federal government should fill budget holes for many reasons, far too many to mention. His wrath toward the nursing homes is just a symptom of a much larger problem. Tragically, they weren’t paying the dancing lion’s sent to collect his tokens for protection through regulatory fines, which is why he felt no obligation to help them with PPE and imposed the mandate that killed and infected senior citizens.  

The Chinese have a token system, too. According to Hermann Rohr’s article: Many dissatisfied Chinese claim: “Nowadays, some people use this tradition to bribe officials.” They apparently give them large sums of cash inside a red envelope or send antique or valuable things to their son’s and daughter’s weddings. If so, benefiting an important person by giving them a red envelope filled with cash is becoming a legal way of bribing officials in China. 

You’ll be out of business if you’re not providing your staff with the right equipment. You’re out of business. That we can do,” he said of state regulations. ~  New York Post 

“Certainly Xi Jinping seems to consider it bribery — it’s one small part of his anti-corruption campaign.” 

“Many patients give them money and if you don’t give [money], they’ll remember you,” Dr. Holmes told the ABC. ~ Christina Zhou and Bang Xiao

Ironically, the printing on the red envelopes, a traditional method of giving money, they’re called…vectors.

You see it now, too. And, it can’t be unseen…

Thank you for reading. Feedback is always encouraged and welcome. ~M. Jane Letty

© 2020 M. Jane Letty/Media Ferret, et. al. All rights reserved.