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VenoStent has a new technology to improve outcomes for dialysis patients

Timothy Bouré and his co-founder Geoffrey Lucks were both near broke when they moved to Dallas to join the first accelerator they entered after forming VenoStent, a company that aims to improve outcomes for dialysis patients.

Failed dialysis surgeries occur in roughly 55% to 65% of patients with end-stage renal disease, according to the company. Caring for these patients can cost the Medicare and Medicaid Services system roughly $2 billion per year — and Bouré and Lucks believed that they’d come up with a solution.

So after years developing the technology at the core of VenoStent’s business at Vanderbilt University, the two men relocated from Nashville to South Texas to make their business work.

Bouré had first started working on the technology at the heart of VenoStent’s offering as part of his dissertation in 2012. Lucks, a graduate student at the business school was introduced to the material scientist and became convinced that VenoStent was on the verge of having a huge impact for the medical community. Five years later, the two were in Dallas where they met the chief of vascular surgery at Houston Medicine and were off to the races.

A small seed round in 2018 kept the company going and a successful animal trial near the end of the year gave it the momentum it needed to push forward. Now, as it graduates from the latest Y Combinator cohort, the company is finally ready for prime time.

In the interim, a series of grants and its award of a Kidney XPrize kept the company in business.

The success was hard won, as Bouré spent nearly three sleepless nights in the J-Labs, Johnson and Johnson’s  medical technology and innovation accelerator in Houston, synthesizing polymers and printing the sleeve stents that the company makes to keep replace the risky and failure-prone surgeries for end stage kidney disease patients.

The key discovery that Bouré made was around a new type of polymer that can be used to support cell growth as it heals from the dialysis surgery.

In 2012, Bouré stumbled upon the polymer that would be the foundation for the work. Then, in 2014, he did the National Science Foundation Core program and started thinking about the wrap for blood vessels. Through a series of discussions with vascular surgeons he realized that the problem was especially acute for end stage renal disease patients.

Already the company has raised $2.4 million in grant funding and small equity infusions. and the KidneyX Prize from the Department of Health and Human Services and the American Society of Nephrology. VenoStent was one of six winners.

“It’s part of this whole ongoing effort by the executive office to improve dialysis,” said Bouré. “[They are] some of the most expensive patients to treat in the world… Basically the government is highly incentivized to find technologies that improve patient’s lives.”

Now the company is heading into its next round of animal testing and will seek to conduct its first human trials outside of the United States in 2021.

And while the company is focused on renal failure first, the materials that Bouré has developed have applications for other conditions as well. “This can be a material for the large intestine,” says Bouré. “It has tunability in terms of all its properties. And we can modify it for a particular application.”

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‘They Just Dumped Him Like Trash’: Nursing Homes Evict Vulnerable Residents

On a chilly afternoon in April, Los Angeles police found an old, disoriented man crumpled on a Koreatown sidewalk.

Several days earlier, RC Kendrick, an 88-year-old with dementia, was living at Lakeview Terrace, a nursing home with a history of regulatory problems. His family had placed him there to make sure he got round-the-clock care after his condition deteriorated and he began disappearing for days at a time.

But on April 6, the nursing home deposited Mr. Kendrick at an unregulated boardinghouse — without bothering to inform his family. Less than 24 hours later, Mr. Kendrick was wandering the city alone.

According to three Lakeview employees, Mr. Kendrick’s ouster came as the nursing home was telling staff members to try to clear out less-profitable residents to make room for a new class of customers who would generate more revenue: patients with Covid-19.

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Credit…Los Angeles County Sheriff’s Department

More than any other institution in America, nursing homes have come to symbolize the deadly destruction of the coronavirus crisis. More than 51,000 residents and employees of nursing homes and long-term care facilities have died, representing more than 40 percent of the total death toll in the United States.

But even as they have been ravaged, nursing homes have also been enlisted in the response to the outbreak. They are taking on coronavirus-stricken patients to ease the burden on overwhelmed hospitals — and, at times, to bolster their bottom lines.

A Lakeview official said the company’s evictions were appropriate and weren’t an attempt to free space for Covid-19 patients. But similar scenes are playing out at nursing homes nationwide. They are kicking out old and disabled residents — among the people most susceptible to the coronavirus — and shunting them into homeless shelters, rundown motels and other unsafe facilities, according to 22 watchdogs in 16 states, as well as dozens of elder-care lawyers, social workers and former nursing home executives.

Many of the evictions, known as involuntary discharges, appear to violate federal rules that require nursing homes to place residents in safe locations and to provide them with at least 30 days’ notice before forcing them to leave.

While the popular conception of nursing homes is of places where elderly people live, much of their business is caring for patients of all ages and income levels who are recovering from surgery or acute illnesses like strokes. Medicare often pays for short-term rehabilitation stints; Medicaid covers longer-term stays for poor people.

Nursing homes have long had a financial incentive to evict Medicaid patients in favor of those who pay through private insurance or Medicare, which reimburses nursing homes at a much higher rate than Medicaid. More than 10,000 residents and their families complained to watchdogs about being discharged in 2018, the most recent year for which data are available.

The pandemic has intensified the situation.

With nursing homes not allowing visitors, there is less outside scrutiny of their practices. Fifteen state-funded ombudsmen said in interviews that some homes appear to be taking advantage of that void to evict vulnerable residents.

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Credit…Andrew Cullen for The New York Times

Many nursing homes are struggling in part because one of their most profitable businesses — post-surgery rehab — has withered as states restricted hospitals from performing nonessential services.

Treating Covid-19 patients quickly became a popular way to fill that financial void.

Last fall, the Centers for Medicare and Medicaid changed the formula for reimbursing nursing homes, making it more profitable to take in sicker patients for a short period of time. Covid-19 patients can bring in at least $600 more a day in Medicare dollars than people with relatively mild health issues, according to nursing home executives and state officials.

“They could be big money for nursing homes,” said David Grabowski, a professor of health care policy at Harvard Medical School.

It is not always about the money. Several states, including New York, New Jersey and California, urged nursing homes to accept Covid-19 patients to help relieve pressure on hospitals. Some nursing home employees worried that would endanger their vulnerable residents.

There is no national data on the number of nursing home residents who have been moved into homeless shelters, motels and other facilities. The New York Times contacted more than 80 state-funded nursing-home ombudsmen in 46 states for a tally of involuntary discharges during the pandemic at facilities they monitor. Twenty six ombudsmen, from 18 states, provided figures to The Times: a total of more than 6,400 discharges, many to homeless shelters.

“We’re dealing with unsafe discharges, whether it be to a homeless shelter or to unlicensed facilities, on a daily basis, and Covid-19 has made this all more urgent,” said Molly Davies, the Los Angeles ombudsman, whose office works with residents at about 400 nursing homes.

In Connecticut, a nursing-home resident was told he had less than a week to pack his things and move to a homeless shelter, according to the resident’s lawyer. In Philadelphia, a nursing home planned to discharge a resident with schizophrenia to the city’s office of homeless services, which was closed during the pandemic. A lawyer said she intervened to stop the eviction on the grounds that it was unsafe.

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Credit…Hiroko Masuike/The New York Times

In New York City, the epicenter of the pandemic, nursing homes tried to discharge at least 27 residents to homeless shelters from February through May, according to data from the New York City Department of Homeless Services. Ombudsmen and city officials blocked many of the discharges, which they said were medically unsafe.

But those figures are most likely a dramatic undercount. “What we’re seeing is just the tip of the iceberg,” said Susan Dooha, executive director of Center for Independence of the Disabled, a nonprofit group that is the home of the Long Term Care Ombudsman Program in New York City.

Traditionally, ombudsmen would regularly go to nursing homes. In March, though, ombudsmen — and residents’ families — were required to stop visiting. Evictions followed.

“It felt opportunistic, where some homes were basically seizing the moment when everyone is looking the other way to move people out,” said Laurie Facciarossa Brewer, a long-term care ombudsman in New Jersey.

Nursing homes are allowed to evict residents if they aren’t able to pay for their care, are endangering others in the facility or have sufficiently recovered. Under federal law, before discharging patients against their will, nursing homes are required to give formal notice to the resident and to the ombudsman’s office. They must also find a safe alternative location for the resident to go, whether that is an assisted living facility, an apartment or, in rare circumstances, a homeless shelter.

But some homes have figured out a workaround: They pressure residents to leave. Many residents assume they have no choice, and the nursing homes often do not report them to ombudsmen.

That is what David Mellor said happened to him. Mr. Mellor, 54, was recovering from spinal surgery that left him numb from the neck down at a nursing home in Fremont, Calif. In April, Mr. Mellor said, the staff at the Windsor Park Care Center, an 85-bed facility, told him that he had to go to a hotel to clear the way for coronavirus patients. Mr. Mellor, who had been trying to arrange long-term housing, felt he had no choice and agreed to leave.

“I saw what was going on,” Mr. Mellor said. “They were forcing people out.” At the Radisson Hotel in Oakland, which was being used to house the homeless, Mr. Mellor said there was no one to help him learn to walk again or to assist him with the medications he takes to control his blood sugar and pain.

A spokesman for the Windsor Park Care Center declined to comment. It is part of a chain owned by Lee Samson, a major fund-raiser for President Trump. “Whatever my political affiliation, Windsor’s commitment to protecting its residents will never be compromised,” Mr. Samson said.

Nursing home evictions can be disruptive and dangerous during normal times — and even more so during a pandemic that preys on the elderly and those with underlying medical conditions.

In March, seven groups that represent nursing home residents wrote to New York’s health department, urging it to stop nursing homes from evicting residents because they are “particularly vulnerable to the Covid-19 virus.” Such discharges, especially to homeless shelters, they wrote, “pose particular public health risks, due to the close living quarters in shelters.” The letter also warned that sending patients from nursing homes — hotbeds of the coronavirus — into the community could hasten the spread of the disease.

Advocates for nursing home residents have also urged California’s health department to halt evictions.

While at least four states have restricted nursing homes from evicting patients during the pandemic, New York and California have not. Some companies appear to be taking advantage.

In California, Rockport Healthcare Services, which manages the state’s largest chain of for-profit nursing homes, has repeatedly been cited by state regulators for illegal evictions.

  • Frequently Asked Questions and Advice

    Updated June 16, 2020

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


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