This week and next will largely determine the fate of healthcare reform. Of course, we in the media have been offering variations on that theme a lot during the past year.

Can the House pass what's pending? That, of course, is the $1 trillion (or so) question. It's still hard to know, but even though the head-counting drill may be getting old, the passions among Americans regarding the bill aren't.

For reform supporters, there is still the belief that any kind of change beats none at all. Of course, this crowd is still trying to recover from that January surprise—when Republican Scott Brown won a Senate seat in Massachusetts and single-handedly changed the political chess match in Washington.

For those who dislike it (and many a reader has expressed such a view), healthcare reform is like a very bitter pill that the government is forcing down their throats. (To check out some of our readers' opinions, go to the comments section under our healthcare reform story today.)

I'll say this: I give the president and Congress kudos for their persistence. They are not accepting defeat, despite numerous setbacks, or the potential political consequences. 

The latest rabbit in the Democrats' hat is a plan to push the massive Senate bill through the House without a direct vote. The maneuver would allow House Democrats to vote on a rule for debate that would deem the bill approved once a smaller package of fixes also had passed.

This tactic doesn't say much about Democrats' faith that Congress can pass a bill by a traditional vote. Not surprisingly, it has drawn widespread criticism from Republicans as an attempt to circumvent the usual legislation process (which, let's be honest, it is).

President Obama, meanwhile, is still trying to round up votes from wavering Democrats. He is hoping for final action by Easter break.

So the drama continues—and likely will build until the proverbial buzzer sounds.

Unfortunately (and this is the last time I'll say this), the clock is running out on any real chance for healthcare reform's passage.

Hungry for information? We thought so. That's why we're offering our fourth annual online expo later this month.

The two-day event, which will take place online, has proven to be a success each year among administrators, directors of nursing and other decision makers at long-term care facilities. And that's not just because it's free (which it is).

One of its most compelling features is its five educational sessions. These one-hour sessions are designed for you, our hard-working, time-starved, knowledge-seeking readers.

The sessions, which will take place on Wednesday, March 24, and Thursday, March 25, will focus on quality, wound care, capital, payment and technology. For the second year in a row, viewers can earn up to five continuing education credits (one for each session).

Here is a brief synopsis of each session:

Quality: Getting from satisfied to very satisfied residents: Margaret Wylde, CEO of the ProMatura Group, will talk about those community attributes that lead to positive resident experiences. (March 24 at 10 a.m. ET)

Wound Care: Becoming a provider of excellence: In this session, Donna Sardina, president of the Wound Care Education Institute, will offer tips on improving wound care programs. (March 24 at 11:30 a.m. ET)

Capital: The prognosis for lending: Here, Michael Hargrave, vice president of NIC Market Area Profiles, will offer his observations of the lending scene and what the future may hold. (March 24, 1 p.m. ET)

Payment: Are you ready for changes in the MDS and RUGs?: This important session will look at the upcoming new resident assessment tools and how providers can prepare for them. Leah Klusch, executive director of the Alliance Training Center, will be the presenter. (March 25, 11 a.m. ET)

Technology: Ways to capitalize on new technologies: Feeling a little behind in this age of new gadgets, gizmos? Peter Kress, vice president of ACTS Retirement-Life Communities, will help you find ways to incorporate innovations in your long-term care settings. (March 25, 1 p.m. ET)

While education is central to the online conference, there are other highlights. A virtual exhibit hall will provide nearly 20 vendor booths that viewers can visit. Attendees also can interact with vendors who are manning the booths virtually.

Of course I am biased, but who wouldn't like to receive useful information for free in the comfort of your office?

Also, I mentioned this point last year, but I have to say it again. The technology behind the expo is pretty darn cool. (For newcomers, imagine seeing all the visual elements of a real trade show—a lobby, exhibit call and presentations—online. Trust me when I say you will feel like you are at a trade show!)

So take a look. (Why not—It's free!) You can sign up at www.mcknights.com/expo. I don't think you'll regret it.

There is more and more talk in state legislatures of finding new ways to dispose of unused medications at healthcare facilities. This is an idea whose time has come.

The amount of drug waste that nursing homes and hospitals generate is unsettling. If a nursing home resident has a bad reaction to a drug, dies, or gets discharged, typically a whole 30-day supply bubble card is thrown away. That's a lot of pills. The Associated Press estimated in a 2009 investigation that at least 250 million pounds of pharmaceuticals and contaminated packaging are generated in medical facilities each year.

The poor, unsuspecting victim of our unused medications is our water supply. Flushing drugs down the toilet contaminates our water, and, by extension, us. And throwing them in the trash isn't necessarily the answer as drugs in landfills still may leech into the groundwater.

Several states have proposed legislation to find new, more environmentally friendly ways to reuse or store the drugs. Some of the ideas have multiple benefits. State Sen. Lois Tochtrop (D) in Colorado recently proposed that nursing homes save drugs to be shipped to Haiti. What could be a better use of unused medication than that?

Another bill in Minnesota would prevent all healthcare facilities from flushing down pharmaceuticals. It and other states also are proposing that pharmaceutical companies pick up the expense for picking up drug waste from people's homes (not nursing homes).

There is some pushback from the pharmaceutical industry. Lobbyists argue that concentrations of pharmaceuticals found in water are extremely low, and are not known to harm humans. Most of what ends up in the water is medicine that people take and excrete, they said, not unwanted meds that are flushed away.

That could be true, but why take the risk? And here's a better reason to find new ways to dispose of unused drugs: If they could benefit people here and around the world, why let them go down the drain?

If all the recent legislative action (or inaction, as the case may be) on Capitol Hill has your head spinning, don't worry-—you're not alone.

In the last week or two, Congress has been scrambling trying to come up with a fix for Medicare physician pay, therapy caps exceptions, state Medicaid assistance, unemployment insurance and a whole host of other programs that were either set to expire or already had.

It can be confusing enough trying to sift through the bevy of bills coming out of Washington at the best of times. But when multiple proposals containing remarkably similar provisions are being discussed and debated and amended and blocked and reintroduced all at the same time, even the guys who make their living tracking legislation start calling each other to ask what the heck is going on.

"It takes someone with such a keen eye right now and such an in-depth knowledge of what's going on," Susan Feeney, spokeswoman for the American Health Care Association, told me Thursday while talking through recent events in Washington. "The morass that's going on up on Capitol Hill is just indecipherable at times."

So what's been passed? What's been blocked? What's going on with all of these temporary "fixes?" Let's sort it all out:

Last Thursday (Feb. 25), the House of Representatives voted on and approved The Temporary Extension Act of 2010, which contains a temporary physician pay and therapy caps fix, as well as extended unemployment insurance through COBRA, through March 31. The Senate voted Tuesday evening to adopt this temporary fix, and President Obama signed it into action hours later.

This is what we have now. Medicare physician pay cuts have been delayed, and the therapy caps exceptions process has been extended until March 31. The big therapy caps exceptions process that is vital to so many long-term care residents and providers is also effective again, retroactive to Jan. 1.

On Monday, at about the same time that all this was going on, Senate Majority Leader Harry Reid (D-NV) and Sen. Max Baucus (D-MT) introduced a larger "extenders" bill that would delay physician pay cuts and extend the therapy caps exceptions process through Dec. 31. It also would extend a temporary 6.2% increase in state Medicaid funding by six months, through June of 2011.

This bill, though it deals with the same issues and was introduced at roughly the same time as the other bill, has not been approved. Dubbed The American Workers, State and Business Relief Act, the proposal is a substitute amendment to the Tax Extenders Act of 2009, which passed the House in December.

"The common thought right now is that this larger extenders bill will be voted on next week," Feeney said. "But anything can happen between now and then. And, anything can be stripped out. So what we're seeing right now that's in it might not be in the final package."

Make sense to you? Yeah, me neither. Maybe I'll focus on something easier to understand, like the fine print in the MDS or curing Alzheimer's.

As a kid, you never wanted to tick off a certain smart-aleck guy from the neighborhood at game time. Not because he was a great player. The truth is he was only average in most sports. But because his parents had bucks and that meant he usually brought nice equipment to the game.

Anyone who has played driveway basketball with an overinflated, slick rubbery basketball can tell you what a joy it is to play with a leather ball instead. The pavement or asphalt is terrible for the life of the leather covering, but while it still has the relatively new feel to it, there is nothing better.

So what does this have to do with elder care? Well, the reason you never wanted to tick off the smart aleck with the primo equipment is you didn't want him to quit and head home in a huff.  With his basketball, football or whatever the plaything du jour was under his arm, of course.

Now, it seems, we could be facing a healthcare scenario where some big kids are threatening to take their ball and go home if they don't get their way. It's come to this point before with physicians and their taxpayer-supported reimbursements, and they win every time. Ever hear of a community's nursing home saying, “Sorry, we're not getting our way so we're just going to board up the windows and leave town.” Not often.

What's so interesting is this time is that it's taken on farcical dimensions. Officials have called for a 21.2% cutback in certain Medicare reimbursements for docs. Did anyone, at any time, ever think this was going to actually fly?

So now we have federal regulators telling providers that, even though the cut officially went into affect Monday, they shouldn't submit claims for doc services because surely Congress or some other act of gods will come to the rescue. And they'll do it within 10 days, too.

But what if the cut isn't reversed? Well, guess who has threatened to take their black bags, close shop and go home, content to sip mint juleps on the veranda until the storm blows over? Or simply stop seeing poorer, often older, patients in favor of more lucrative, well-to-do customers -- er, patients.

That's right, the kid with the ball that everyone wants -- no, needs -- to play with. As youngsters, there were times we'd eventually just get fed up with the smart aleck and tell him to take a hike, nice equipment and all. When it comes to real-life healthcare, however, that's obviously not so easy to do.

So the physicians will again win on the payment issue at hand. It's just a matter of how much they'll get -- and how much they'll take out of a pool that other providers also draw from.

The good news is this should require some sort of bipartisan cooperation in Washington. That's right, a Democrat might actually have to agree with a Republican and vice versa. And something will be accomplished. And it might actually show a politician or two that thinking with one's own head -- for the good of the people -- isn't a fatal flaw.

Talk about setting a dangerous precedent.

Politicians love to toss out stories of individuals adversely affected by the healthcare system. You always hear them say, “I've heard from a family in Michigan that lost its insurance,” or “There's a man in Macomb who can't afford a new hip” or “There was an old woman who lived in a shoe…”

But while watching the healthcare reform summit on Thursday, I heard a particularly macabre story from New York Democratic Representative Louise Slaughter.

Just before the gathering split for lunch (appropriately enough), Slaughter told the attendees of a poor older woman in her district who was so desperate for dentures, she literally took a pair out of the mouth of her recently deceased sister.

Personally, I'm always a bit skeptical of these stories. Slaughter herself acknowledged the incredible nature of the story, but swore to its validity. True or not: Ewww.

But true or not, the story also highlights the continued need to provide adequate services and supports for the elderly.

It seems as if almost every day we come across stories of state budget troubles, bankrupt Medicaid programs and proposed cuts to senior services. And the first services to go are usually services such as vision and, as the woman in Rep. Slaughter's story can clearly attest, dental.

We all know what a troubled state our economy is in, and we all know that there are going to be some tough choices ahead. And a one-day televised bipartisan summit to discuss the entire healthcare reform bill probably isn't going to have much effect.

But hopefully, stories like Slaughter's will keep some of the focus on the seniors who are usually the first to lose out when the Medicaid program gets cut.

The release of President Obama's healthcare reform proposal couldn't have come at a better time. The American Association of Homes and Services for the Aging is holding its advocacy conference in the capital this week.

Members will stress to their congressmen the importance of passing a healthcare bill when they visit their lawmakers Tuesday. They will urge them to support the CLASS (Community Living Assistance Services and Supports) Act, which has made it into the proposal. The insurance program, which received a lot of publicity during the throes of the healthcare reform debate last year, would allow people to pay into a trust that would give them a cash benefit if they become disabled.

The proposal also would close the Medicare Part D doughnut hole and use Medicaid to expand home- and community-based services. Transparency requirements are also a major part of the proposal.

AAHSA CEO and President Larry Minnix, for one, is impatient for Congress to pass a bill. He wants members to clearly explain to Congress the importance of the CLASS Act.

"Our job is to help them connect the dots," he said.

By connecting the dots, he means explaining that the CLASS Act's cash benefit would allow seniors who are unable to perform acts of daily living to stay in their homes. Injecting private money into the long-term care system also would provide savings to Medicaid, and help the healthcare system as a whole, he argues.

He also likes other elements of healthcare reform, such as preservation of the market basket, and concepts to examine how long-term care interacts with other elements of the healthcare system. Both the House and Senate bills meet AAHSA's criteria and position statement, he said.

Of course, supporters of reform like Minnix recently were disappointed. But he said he still feels hopeful that a bill will pass.

And if one doesn't? Is there a plan B for the CLASS Act?

"Plan B is it's still a good idea," he said. "We're not giving up on it."

Lawmakers, take note. 

When long-term care providers hit Capitol Hill Tuesday their congressmen better be prepared.

Members of the American Association of Homes and Services for the Aging, who will be in Washington for their annual advocacy meeting, will make several important requests. Among them: Reinstate the exceptions process for Medicare Part B therapy caps, increase the Medicare market basket for fiscal year 2011. Also, by the way, how about that healthcare reform bill?

Of course, long-term care providers will be more diplomatic with their talking points, but the underlying message is clear: It's time to take some action.

Coincidentally, the congressional visit falls the same week President Obama is staging a healthcare summit. Its stated goal is to iron out partisan differences that are holding back healthcare reform. The invitation may be an admirable gesture, but already it appears to be on shaky ground.

A recent news report found that Democrats may not have any concrete plans to present and Republicans aren't buying what's on the table. The gridlock is enough to make you throw up your arms and take the next flight to Vancouver. (At least there things are getting decided. So what if it's an Olympic medal instead of a jobs bill and on the ice rink instead of the Senate floor!)

But the reality is certain items, like the therapy caps provision, desperately need Congress to act. People's health is at stake.

Lawmakers should not take lightly the visits from their AAHSA constituents. These people are not just coming to complain. Providers and their residents sincerely are asking for solutions.

The horror in Haiti has struck home for Port Chester Nursing and Rehabilitation Centre. Certified nursing assistant Marie Rosela Anacreon died during the earthquake. She had been visiting her mother in Port-au-Prince.

Her death has deeply touched the employees and residents of the 160-resident facility in Port Chester, NY, Administrator Carol Spedaliere said.

“The facility has very long-term employees,” she said. “It felt like one of the family was lost.”

Anacreon had just celebrated her 10th anniversary at the nursing home when she left on vacation. She worked the 3 p.m. to 11 p.m. shift and was close to the residents.

“The residents on her assignment were just devastated,” Spedaliere said. “Everyone knew her. It was really a loss for them.”

As a way to honor her memory, employees established a compassion fund. Employees were asked to donate vacation days, sick days or personal days. They raised a total of $12,000 (the cash value of those days), which they donated in her name to the charity Doctors Without Borders. About 80% of the employees participated, Spedaliere said.

“It made everybody feel so much better,” she said. “I think that really helped bring closure to it.”

The staff didn't even know that Anacreon, 58, was in Haiti. She had told them that she would be going to Florida. She and her sister must have decided to visit Haiti at the last minute, Spedaliere said. Her sister had left Haiti earlier, but Anacreon didn't. Anacreon's mother, Laurette St. Martin, also died in the earthquake. The staff learned the sad news from Anacreon's sister.

The handful of other Haitian staff members at the facility had just received confirmation that their families were safe when they heard about Anacreon.

“Everyone kind of took a deep breath and then we found this out,” Spedaliere said.

A ‘generally wonderful person'

The facility lost a dedicated employee.

Anacreon was hardworking and “extremely responsible,” Spedaliere said. “She was at work every day.”

While Anacreon was upbeat, she was “serious enough to know she has to do her job and take care of her residents,” Spedaliere said.

A mother of three, she also was raising a grandchild.

“She was a mother and a grandmother and just generally a wonderful person,” Spedaliere said. 

The death of Anacreon is “a personal loss,” she added. Spedaliere says that when she walks the unit, “I'm conscious of her not being there.”

Residents and staff, who have been watching the ghastly story unfold on TV, feel closer to the events in Haiti.

As for herself, Spedaliere “will forever remember the people in Haiti, not just today, but I'll remember what they need for a long time.”

That is certain to be the case for all the people who knew Anacreon—and loved her.

Imagine finding two bags with thousands of dollars in it. Then consider returning them to a nursing home, the rightful owner. That's what Barry Stringer did, and news of his good deed has stretched far and wide.  

Steven Yokley, administrator of NHC Healthcare, said the act reaffirmed his faith in other human beings.

“From my perspective, to know that in a world today when you only hear the negative things that occur, there's lots of positive people who do the right thing,” observed Yokley, who runs the 211-bed nursing home in Dickson, TN. (A total of 191 beds are skilled; the rest are assisted living.) He spoke to me this week from his facility, which is about 45 minutes from downtown Nashville. 

In case you have missed this “feel-good” story, about two weeks ago, Stringer, a dental assistant, found two green deposit bags of cash and checks on the ground outside Yokley's facility. He returned them the next day.

“I knew what I was going to do with them as soon as I found them, even before I opened them,” said Stringer, according to The Dickinson Herald newspaper.

After finding the bags, he took them to the bank. When he found the bank closed, he called the facility the next day and spoke to the bookkeeper.

“I asked her, ‘Did you lose something yesterday?” Stringer told the Herald. “She said, ‘Like what?' I said, ‘I don't know, you tell me.' She said, ‘Yes, I lost something yesterday.” I told her I found it and she was just hysterical about it.”

There's a good Samaritan for you.

So what, you may be asking, was all this money—$200 in cash and $71,800 in checks, according to Yokley—doing on the ground? The employee who was supposed to take it to the bank had left it on the top of her car and drove off, Yokley said. The facility noticed it missing within the first five minutes.

Oops.

Yokley, speaking about the incident, did not seem fazed, despite the publicity it generated.

“It was an honest mistake,” he noted. 

Of course, it must not have been easy for the facility to go 20 hours without knowing where thousands of dollars from operations were. But because most of the money was checks, Yokley said he was not too worried. The facility was following policies to protect the deposit. The only real loss would have been $200, he explained.

But when Stringer returned the money, “we definitely showed our appreciation to him,” Yokley said. “He's a very humble gentleman.”

Stringer did not receive a financial reward, but he knew the facility was grateful, Yokley said.

Of course, the news, which has spread nationwide, also must also be a kind of reward in itself.

Stringer should bask in the media hype. Not everyone would have been so honest.