South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The New York Times had an interesting article about the growing industry of long term care hospitals.  The greedy owners manipulate the Medicare and Medicaid regulations on reimbursement to make even more money and profit.

Fewer than 10 hospitals dedicated to long-term care existed in the early 1980s, according to Medicare officials.  More than 400 long term care hospitals have opened nationally in the last 25 years.   These hospitals have sprouted driven by Medicare rules that offer high payments for hospitals that treat patients for an average of 25 days or more.  Long-term care hospitals now treat about 200,000 patients a year, including 130,000 Medicare patients — at a projected cost of $4.8 billion to the government this year, up from $400 million in 1993. 

Among the more peculiar aspects of long-term care hospitals is that nearly half of them, and almost all of Select’s, are actually “hospitals within hospitals.” They do not have their own buildings and instead occupy a floor or two of an existing hospital. They contract most services from the host hospital, so they can be opened quickly and cheaply.

Yet under Medicare rules, because they have different owners, the two hospitals are considered separate for payment purposes. This means there can be a second reimbursement when a patient is simply transferred between floors.  Under Medicare payment rules, traditional hospitals often lose money on patients who stay for long periods. So they have a financial incentive to discharge patients to long-term hospitals, which then receive new Medicare payments for admitting the patients. Both hospitals benefit financially.  The industry’s growth is an example of how health care companies can exploit the $450 billion Medicare program.

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USA Today had a great article on the excessive number of nursing homes that receive taxpayer money but refuse to meet the minimum requirements for quality of care.  The requirements are basic and necessary services, and fundamental safety and food standards. Personal hygiene, responding to call bells, fresh foods, hot water, taking vital signs, etc----basic stuff but because of greed and short-staffing one in five of the nation's 15,700 nursing homes have consistently received poor ratings for overall quality.

More than a quarter-million patients live in homes given another set of low scores within the past year, according to data released today by Medicare, which first released the star ratings of the nation's nursing homes in late 2008. The ratings are derived from inspections, complaint investigations and other data collected mostly in 2008 and 2009.

USA TODAY found that all 50 states and the District of Columbia have homes with poor ratings from one year to the next.  And dozens of those facilities are the only nursing homes for miles.

Late in the Bush administration, the Centers for Medicare & Medicaid Services began assigning nursing homes one to five stars for quality, staffing and health inspections, as well as an overall score. Nearly all homes that repeatedly received few overall stars — one or two stars — were owned by for-profit corporations, the data show.

"The issue is the owners have to take responsibility for the consequences" of poorly performing homes, says Larry Minnix, CEO of American Association of Homes and Services for the Aging.

The newspaper's analysis found the lowest-rated homes had an average of 14 deficiencies per facility, which can include quality-of-life measures and safety violations.

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The Billings Gazette had an article proving that for-profit nursing homes provide less quality care than non-profit nursing homes.  A disproportionate number of Montana nursing homes rated below average by the government are operated by for-profit corporations, an analysis shows.   Almost 60 percent of the state’s skilled-nursing facilities awarded one or two stars by Medicare are for-profit entities, according to information available on the government’s Nursing Home Compare Web site.  For profits tend to cut corners and decrease staffing for profit and bonuses.

Medicare rates nursing homes on a five-star scale using data collected during annual inspections. Facilities are also scored on their staffing levels and how they perform on certain quality measures. Some 26 of Montana’s 90 nursing homes earned one or two stars in the most recent analysis. One star is “much below average” and two stars is “below average,” according to Medicare. 

“I don’t think it means a lot,” said Jerry Smyle, vice president of operations for Lantis Enterprises Inc., which owns 12 for-profit nursing homes in Montana.

Of course, he doesn't.

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St. Louis' STLToday.com had an interesting article about the change in demographics at today's nursing homes including healthy mentally ill patients sharing homes with elderly vulnerable residents.   The conventional wisdom is that nursing home residents are frail and elderly. That's not the reality.   Increasingly, adults with serious mental illness are being housed and cared for in  nursing homes.  Nationally, the number of mentally ill nursing home patients has jumped by 41 percent since 2002, an analysis by the Associated Press showed. In Missouri, it climbed by 76 percent. 

The article discusses the recent forced closure of Whispering Oaks after a well that supplied water froze, causing toilets to overflow. The facility had a history of fire and safety violations. State nursing home regulators tried to suspend its license last June. Whispering Oaks housed a number of patients with serious mental illness.   Several were relocated to another nursing home in St. Louis — owned by a psychiatrist — that also has been cited for safety violations in the past two years.

In theory, no one is supposed to be admitted to a nursing home unless he has disabilities that require extra care or supervision. That requirement is contained in the 1980s-era federal Nursing Home Reform Act.   But state officials estimate that about 2,500 people are in Missouri nursing homes primarily because they are mentally ill. They could be treated in a less restrictive — and less expensive — setting.  Missouri consistently has failed to fulfill its responsibilities to people with mental illness. The share of state funding for treating the mentally ill has been shrinking for decades.

Missouri could get federal money to help provide housing and treatment to patients with serious mental illness — but only if it came up with matching state funds, which the Legislature has refused to do.  The result of this neglect isn't just tragedy for the mentally ill. In Illinois and other states, it's also a tragedy for elderly nursing home patients and their families.

When the state budget is tight and elderly people are increasingly opting for home care, it's tempting to see nursing homes as a short-term solution to the chronic lack of care for the mentally ill. It may be tempting, but it is wrong.

People with mental illness deserve housing and care in the communities where they live, not in facilities designed for the frail elderly.
 

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Oregonlive had an article about SunWest's recent sale of nursing homes.  Sunwest Management has signed a deal to sell 134 of its senior housing facilities to a group led by private equity giant Blackstone for $1.15 billion in cash and assumed debt.  The price is lower than the approximately $1.27 billion price tag discussed last September when the deal first came to light.  Blackstone Real Estate Advisors VI LP is leading the acquisition group. Teaming with Blackstone are Seattle-based Emeritus Senior Living and Columbia Pacific Advisors, an entity controlled by Dan Baty, chairman and co-CEO of Emeritus.   Baty went to considerable lengths to win a seat at the negotiating table. His company, Columbia Pacific, bought up $290 million in debt that various Sunwest entities owed to lenders and shrewdly attempted to use its new position as a creditor to leverage a better deal out of Sunwest.

Sunwest was once the fourth-largest assisted living company in the country. It fell into disarray in 2008, a victim of the credit crisis, its own out-of-control growth, greed, mismangement, and poor quality of care. The company's crash led to one of the largest investment scandals in Oregon to come out of the economic downturn. In the summer of 2008, Sunwest affiliate companies stopped making promised interest payments on the more than $400 million it owed to some 1,200 investors.

The U.S. Securities and Exchange Commission sued Sunwest and its former CEO, Jon Harder, in March, accusing the company of running a Ponzi-like scheme. Like nearly everything about Sunwest, the proposed sale to Blackstone is controversial. Some investors feel that Blackstone is offering a lowball price. The bid must be approved by U.S. District Judge Michael Hogan, who has been overseeing a complex legal mediation involving Sunwest, its investors and lenders since early this year.

If the Blackstone/Emeritus group does not prevail, it could be entitled to $13 million in breakup fees and expense reimbursement, according to court documents outlining the tentative deal.

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Yahoo had Omega's Form 8-K/A filed with the SEC on Jan. 15, 2010.  The form discusses the acquisition of dozens of nursing homes from CapitalSource. 

On December 22, 2009 Omega Healthcare Investors, Inc. ("Omega") acquired certain subsidiaries of CapitalSource Inc. ("CapitalSource") owning 40 long term care facilities (the "Acquired Facilities"), and an option to purchase other CapitalSource subsidiaries owning 63 additional facilities for an aggregate purchase price of approximately $294 million, consisting of: (i) $184 million in cash; (ii) 2,714,959 shares of common stock of Omega, valued at $51 million under the Purchase Agreement; and (iii) assumption of $59 million of mortgage debt.

The Acquired Facilities consist of the following:

1. Airamid Health Management with 998 beds and 9 facilities
2. Community Eldercare Services with 120 beds and 1 facility
3. Conifer Care Communities, Inc. with 120 beds and 1 facility
4. Elite Senior Living with 105 beds and 1 facility
5. Gulf Coast with 815 beds and 6 facilities
6. HMS Holdings with 123 beds and 1 facility
7. Prestige Care with 90 beds and 1 facility
8. Sava Senior Care with 640 beds and 4 facilities
9. Southwest LTC with 260 beds and 2 facilities
10. TenInOne / Delanco Healthcare with 1,516 beds and 10 facilities
11. Trans Healthcare, Inc. with 381 beds and 3 facilities
12. The Waters with 96 beds and 1 facility
 

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Life and Time Health Insurance reported that spending on nursing home care climbed to more than $138 billion in 2008, up 4.6% from the 2007 total, according to federal analysts.  The "good" news is that the rate of increase decelerated from 5.8% in 2007.   Analysts from the Centers for Medicare and Medicaid Services have reported those figures in the latest issue of Health Affairs, an academic journal that covers health care finance and delivery systems.

The slowdown in the LTC spending growth rate was due partly to reduced growth in private spending on nursing homes.  Private payers account for 38% of total spending on nursing home services.  Increases in nursing home care prices fell to 4% in 2008, from 4.7% in 2007, and that also contributed to the deceleration, the researchers report.

Meanwhile, public spending for nursing home services grew slightly faster than the year before because of increased growth in Medicaid nursing home spending.  Medicaid, which accounted for 41% of total nursing home spending in 2008, saw spending on that item grow 2.6% in 2008, after growing just 2.6% in 2007 and 1.5% in 2006.

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I saw this press release from Brown University.  Interesting conclusions based on data.

Hispanic senior citizens are living in nursing homes in ever-increasing numbers, but they face a gap in their quality of care compared to white residents, according to new research from Brown University. 

A team led by Mary Fennell, professor of sociology and community health, found that Hispanic elderly are more likely than whites to live in nursing homes of poor quality. These residences are often faced with structural problems, staffing issues and financial trouble.

Details will be featured in the January 2010 edition of Health Affairs. The research follows up and expands upon a landmark 2007 study, also published in Health Affairs, suggesting that blacks are more likely than whites to live in poor-quality nursing homes. Vincent Mor, chair of the Department of Community Health, was a lead author in that study and is a co-author in the new work looking at nursing home care for Hispanics. Temple University was also a partner in the previous research.

Fennell said the paper is the first full-scale analysis of its kind to attempt to look broadly at Hispanics in nursing homes — what kind of nursing homes they live in and how care at those facilities compares to nursing homes which care mostly for white elderly people. She said the data revealed a sharp disparity in care.

"The most shocking finding is the pervasiveness of disparities in nursing home care that are primarily white, compared to nursing homes that are a mix of whites and Hispanic residences," Fennell said.

Fennell said the findings, in part, reflect a departure from prior patterns of elder care among Hispanic families in the United States. Traditionally, the group has used formal long-term care services less frequently than any other U.S. ethnic group. They had also been less likely than white or black residents to live in nursing homes. In Hispanic households, elder care has traditionally been handled by adult daughters at home, but acculturation and financial issues have forced a growing number of young Hispanic women into work outside the home.

As a result, Fennell said, the loss of home caregivers is occurring even as the growth of the elderly Hispanic population rises dramatically. The authors estimate that more than 5 percent of the current Hispanic population is elderly, a number that is expected to quadruple during the next 10 years. That number should rise to 4.5 million by 2010, according to Fennell and her team.

Fennell and her colleagues found that the overall use of nursing homes has declined since 1985, but the racial/ethnic mix of the national population of nursing home residents has shifted. From 2000 to 2005 — the period of data used in the study — the percent of Hispanic residents increased from 5 percent to 6.4 percent, but the percentage of non-Hispanic white residents dipped from just under 83 percent to 79.4 percent.

Nursing home residents are coming increasingly from the lower end of the socio-economic scale, Fennell said, lacking resources for better quality care in assisted living facilities or elsewhere.

Fennell argues that the impact of substandard nursing home care is a complex issue. Residents admitted to nursing homes have often already endured hospitalizations or a health issue that required expensive, high-level care. Once admitted, the individual is then often caught in a spiral of long-term lower quality of life, multiple episodes of poor health and ongoing chronic conditions without a way out.

"People with resources can get into very good places or alternatives for nursing home care," Fennell said. "Everyone else is left with not-very-good facilities that are not performing well."

Fennell is hoping that both federal and state policy-makers pay attention to the data as they shape health care reform policy.

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McKnight's had an article about end of life programs in nursing homes.  Fewer than one in five nursing homes provide end-of-life care services, according to new research from the American Association of Homes and Services for the Aging.   However, any expansion would have to deal with the "death panel" demagoguery.  These programs are necessary to assist residents and their families regarding their rights to end of life decisions.

As many as 25% of all deaths occur in the U.S. occur in a nursing home, according to the report from AAHSA's Institute for the Future of Aging Services.  Despite this, less than 20% of nursing homes offer end-of-life programs. Nursing homes were more likely to participate in end-of-life programs if they also offered specialty programs for hospice, pain management or dementia care, according to the report.  

There is also a link between staff training in end-of-life care services and a facility's participation in end-of life-programs, the report showed. Providing appropriate staff training may be the key to expanding program participation, according to Helaine Resnick, director of research at IFAS. The research was published in the online version of the American Journal of Hospice and Palliative Care Medicine.
 

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Ohio's Newsnet5.com had an article about their investigation into Ohio nursing homes.  Working with their partners at Scripps Howard News Service, NewsChannel5 spent three months researching care homes.   NewsChannel5 found poor ratings for a number of Cleveland-area nursing homes. In fact, a quarter of the facilities in Cuyahoga County rated just one star on Medicare's five-star scale. Five other ManorCare properties in the area garnered just one star.

"There should be two kinds of nursing homes the excellent and non existent," said Larry Minnix, chief executive officer of the American Association of Homes and Services for the Aging.

Long-term care ombudsman, Gerald Kasunic, said, "If you smell urine or feces, or what I call the chemical hidden smell, something that may be a serious chemical odor, those are kind of bad signs."

According the SHNS and WEWS study of death records maintained by the Centers for Disease Control and Prevention, nearly 19,000 people died in area nursing homes in 2005 and 2006. Of those deaths, 651 people died of accidents, skin infections or other potentially avoidable causes.

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