The Associated Press/Washington Post: For many older Americans who lost jobs during the Bush recession, the search for reasonable health care has been one obstacle after another. They’re unwanted by employers, rejected by insurers, struggling to cover rising medical costs and praying to reach Medicare age before a health crisis. These luckless people, most in their 50s and 60s, have emerged this month as early winners under the nation’s new health insurance system. Along with their peers who are self-employed or whose jobs do not offer insurance, they have been signing up for coverage in large numbers, submitting new-patient forms at doctor’s offices and filling prescriptions at pharmacies
What lobbying group donated the most money to political campaigns for the legislators and governor of Louisiana? You might guess oil and gas, telecommunications, or banking. If you did, you were wrong. For-profit nursing homes topped all of those with $2.8 million dollars contributed to various political campaigns in an attempt to gain influence and push laws favorable to their continued profitability. Governor Bobby Jindal alone received more than $715,000. Louisiana has the lowest ranked nursing homes in the entire nation, and some nursing home owners who are the most generous donors just happen to own some of the worst nursing homes in the state. A closer look at reporting for the state shows for-profit homes generally rate lower quality with average of 2.5 out of 5 and non-profits at 3.5 out of 5.
So what do these for-profit nursing homes get out of all this generosity? One Louisiana law sets a cap on fines. For instance, a violation that results in the death of a resident now results in a fine no larger than $2,500, even if the death is entirely the nursing home’s fault.
We might also look at the Jindal administration’s budget, which has increased nursing home spending while simultaneously cutting funding to LSU hospital system, slashing Medicare payments to private hospitals, reducing Medicaid payments to rural hospitals, and completely shutting down a hospital for the mentally ill.
How is the administration paying for the nearly $800 million in nursing home funding when the rest of the healthcare system is being forced to take cuts and closures? By draining a trust fund intended to provide elder care for years to come. The fund is intended to be used over a long term and should also provide support for in-home care and community services for the elderly. At the rate that the trust fund is currently being emptied into for-profit nursing homes, there will be nothing left by the time Jindal leaves office in 2016.
Roughly 20,000 Louisiana residents are on a waiting list for in-home care, while demand for nursing home beds has gone down. Nursing homes in the state remain only 75% full. The slump in demand isn’t bad news for these for-profit businesses however. They get a kickback for vacancies too. Once the numbers are crunched, all those empty beds cost the state and taxpayers $23 million dollars to support.
All of these revelations are the result of a four-month investigation and report by NOLA.com | The Times-Picayune and WVUE Fox 8 News which culminated in their report series Louisiana Purchased. The report on nursing homes may be watched here.
Thanks to the American Medical Directors Association, prescribing antipsychotic drugs is no longer a justifiable part of a care plan when treating dementia patients. A free resource is now available to health care providers that focus on providing patients with activity programs, social engagement and mental stimulation. However, it is unlikely that this program will be utilized in the majority of nursing home facilities, because the program requires staff to take extra time with patients for behavioral therapies and strong care team communication. Most nursing homes are minimally staffed, with staff unable to provide even the most basic levels of care to residents.
Even though viable opportunities are available to maintain the vitality of the aging population, it is unlikely that the prescription of antipsychotics to dementia patients will have any sort of significant decrease. Antipsychotics tend to have very serious side effects that often interact negatively with an aging person’s body chemistry. These drugs essentially place dementia patients in what is known as a ‘chemical restraint,’ making the patient unable to function normally. Therefore, because of the costs associated with providing the proper care to dementia patients in long-term-care facilities, the owners of these facilities will continue to sacrifice the well being of their residents in order to continually increase their profits.
THV11 reported the guilty plea of Courtney Lynn Goodwin for stealing pain medication that had been prescribed to residents of the long-term care facility where she worked. Goodwin pleaded guilty to obtaining a controlled substance by fraud, a Class D felony. Goodwin, a licensed practical nurse, was a nurse supervisor at Pine Lane Therapy and Living Center in Mountain Home.
She was arrested in October 2013 after an internal investigation at the long-term care center and an investigation by the Attorney General's Medicaid Fraud Control Unit. Investigators determined that Goodwin had taken for her personal use hydrocodone/acetaminophen pills that had been prescribed to three residents of the center.
Steven Littlehale is a gerontological clinical nurse specialist, and EVP and chief clinical officer at PointRight Inc. He wrote the below article for McKnight's.
You've heard the adage: “If it wasn't documented it wasn't done”, but does anyone actually think that's realistic or meaningful? Yet sadly, millions of dollars have been paid by nursing homes who unsuccessfully defended themselves against incomplete or absent documentation. There are not as many legal guidelines regarding medical records maintenance as you might think; however, there are essential legal aspects of charting to keep in mind. Poor legibility, lack of dating, timing, and signing entries, improper labeling, spelling/grammar errors, inconsistent data entries, use of unauthorized abbreviations, mistaken/erroneous entries, and delays and gaps in charting, are the most common findings under scrutiny during a records review process.
During the initial phases of discovery, the medical record is regarded as a repository of information. The contents and quality of the record speak volumes about the standard of care and any potential deviation. Therefore maintaining, organizing and storing medical records should be regarded with a high level of importance.
Most nursing homes have policies and procedures for responding to requests for medical records by an outside party such as a plaintiff attorney or family member. If your facility does not, immediately consult with counsel and establish one. This is not a corner to cut.
Does your policy instruct that MDS assessments should be included? Typically these assessments are not included as part of record requests. However, the MDS could provide details of a resident's care over time; changes in medical condition, physical and cognitive functioning, medications, diagnoses and treatments. The MDS describes what the resident is at risk for and what you're doing to prevent a negative outcome or worsening of a condition. The MDS can significantly influence the interpretation of care.
Set yourself up for success! These five tips will improve any record you produce.
•Instill within your organization awareness of the importance of handling, organizing, maintaining, and storing the medical records.
•Systematically and consistently conduct chart audits to determine potential problems and erratic trends in charting.
•Invest in an MDS data accuracy program to ensure that incongruent MDS data entries are identified early on before final submissions to CMS or third party providers.
•Incorporate analysis of the MDS assessment forms during the initial phases of the records review process; use the MDS assessment to guide the review focus.
Know that the medical record is always pulled for review, regardless of the type of claim or allegation. By establishing good policies, providers can save themselves many headaches.
The Des Moines Register reported that Mary Morse-Bolton, an Iowa nursing home owner, allegedly owes the state more than $400,000 in Medicaid overpayments, unpaid fines and unpaid taxes but continues to operate nursing homes despite numerous allegations of poor resident care and improper billing. For some unknown reason, Morse-Bolton has not been sanctioned for failing to pay the fines that date back to 2009. Her nursing home administrator’s license remains in good standing with state regulators.
In April 2010, the Iowa Department of Inspections and Appeals alleged that one of her care facilities, Faith Ridge Life Center in Malvern, failed to ensure that residents were treated with dignity and respect, despite numerous staff and resident complaints of abusive conduct by one particular nurse aide.
The nurse aide allegedly boasted to a colleague that she would rub strawberries inside the water glass of a resident who was known to be allergic to the fruit. Nine co-workers alleged the aide also told residents to shut up; left the residents in urine-soaked clothing; concealed resident injuries from the nursing staff; told residents she was “too busy” to meet their needs; and switched off residents’ call lights without providing any assistance.
As a result of the inspectors’ findings, the state imposed a $1,500 fine against Faith Ridge. It was the home’s third fine in three months for failing to treat residents with dignity and respect. Today, nearly four years later, the $1,500 fine remains unpaid, and no sanctions have been imposed against the home for lack of payment. There appear to have been no efforts made to collect the fine for the past two years.
Companies controlled by Morse-Bolton have, in the state’s words, “repeatedly demonstrated poor quality” in delivering home-based services to the mentally disabled, and that they have, for the past nine years, repeatedly failed to provide documentation to support their billings to the taxpayer-funded Medicaid program.
Then, last fall, the state notified Morse-Bolton that Faith Ridge was two years behind in paying a quarterly health care tax imposed on all Iowa nursing homes. At the time, the state alleged, Faith Ridge owed $287,000 in delinquent taxes.
At the same time, the state notified Morse-Bolton that she owed the state an additional $165,315 for Medicaid overpayments that were routed to Kevington Lane, a care facility she operates in Sidney.
This blog has followed the case of Mynez Carter, an elderly woman who was abused by staff at the nursing home where she was staying. Not only was she abused, but her family, suspicious of her change in behavior, set up a camera which caught some of the shocking acts on tape. Maria F. Acosta, the aide who was caught on camera abusing Ms. Carter pled guilty and could have faced up to 10 years in prison.
After reviewing the footage from the hidden camera as well as a pre-sentencing report, the court has sentenced her to only 90 days in jail and 5 years deferred adjudication probation. Incredible that this mean vicious aide only gets 90 days when there is video proof of her abuse of a vulnerable adult. If this was a video of her abusing a child or animal, she would have gotten more time.
It might be comforting to assume this was a case of a bad apple that slipped through the cracks, but a quick review of the DHEC inspection report for the facility shows multiple problems with communication, administration, staffing, and policies within the facility. These issues affected more residents than just Ms. Carter, and were present with other staff members ranging from other aides to the director of nursing. These facts from the report all point to a systematic failure by the facility, not merely one bad employee with a mean streak.
NBC Chicago reported that medication errors in nursing homes are leading to hospitalizations for dangerously low blood sugar, visual hallucinations and labored breathing, according to information obtained by NBC 5 Investigates via a search of public records. Sometimes handwriting can cause errors in terms of dosage. The errors can result in a resident getting the wrong medication, too much medication or not enough medication.
State health inspectors documented 384 nursing home medication errors since 2011. The number of medication errors is likely much higher since nursing homes self-report and often cover-up medication errors. Illinois currently has a 9% facility citation rate for medication errors. However, the state's goal is a 5% citation rate.
KUSH reported that Deborah Jean Craft, business office manager for Westhaven Nursing Home in Oklahoma, was arraigned on a charge accusing her of embezzling $1,645 in cash payments between Jan. 14, 2013, and Oct. 1, 2013.
Stillwater Police Detective Richard Leport wrote in an affidavit that on Oct. 28, 2013, Stillwater Police Officer Chet Skimbo met with Westhaven Nursing Home administrator Micah Quick. "Ms. Quick reported business office manager Deborah Jean Craft had been embezzling funds from Westhaven Nursing Home," the affidavit alleged. The resident provided six receipts signed by Craft dated between Jan. 14, 2013, and Oct. 1, 2013, totaling $1,645, the affidavit said. "Ms. Quick was unable to locate any record of the cash," the affidavit alleged.
She was allowed to remain free on a personal recognizance bond pending a March 3 court appearance when she can ask for a preliminary hearing on the felony charge. If convicted of embezzlement, Craft could be given a five-year prison term, a $5,000 fine and an order to pay restitution.
A man is paralyzed from the neck down after being attacked by a fellow resident at his Queens adult home — at least the second serious incident at medical homes on the Rockaway peninsula in recent months, according to the NYPD and police sources. Apparently the facility is so short staffed that they cannot supervise the residents.
The victim and the suspect got into an argument inside a recreation room at The New Gloria's Manor on Beach.The suspect punched the victim in the face, causing him to fall and hit his head on a table. While both were on the ground, the alleged attacker, identified as Bienvenido Cruz jumped on the victim's chest and continued to pummel him four to five times. No staff intervened.Cruz then slammed the victim's head into the table at least five times, according to an eyewitness.
The victim is paralyzed from the neck down, according to the criminal complaint. Cruz who has a prior arrest for weapons possession in Suffolk County, was charged with felony assault.
See full article here.