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

A new article, 'Torts Provide Best Relief for Nursing Home Residents,' is now available free from Clifford Law Offices web site at http://www.cliffordlaw.com. The Chicago law office is posting legal articles on their website in an effort to educate the public about legal matters.

Torts Provide Best Relief for Nursing Home Residents

Clifford's Notes, Chicago Lawyer, 08/01/2005
By Robert A. Clifford

A man in his 70s with a psychotic disorder, known as someone who smokes in prohibited areas, sneaks out of his room in a Niles nursing home when two of the three nurses on duty are on a break.

He leaves the dementia unit and wanders into an unused wing of the hospital, where he lights a cigarette that causes most of the room to be engulfed in flames. He is burned over 25 percent of his body, and both of his legs have to be amputated.

Another nursing home in suburban Niles fails to adequately supervise a 71-year-old woman who falls down the stairs in her wheelchair.

In Chicago, a nursing-home care worker is charged with involuntary manslaughter earlier this year after she allegedly attacked a 62-year-old resident, dragging him out of bed and causing him to fall and break his hip. He dies of a heart attack a week later, and the Cook County Medical Examiner’s Office rules it a result of the stress of the assault.

Reports of nursing-home abuse appear to be on the rise for a number of reasons: the growing aging population, a greater cognizance of neglect and abuse of the elderly and the increasing specialized care for the aged. Projections of 2000 census data indicate that the elderly population will rise to 71 million Americans by 2030, more than twice the number counted in the 2000 census. By 2050, the elderly population is expected to reach nearly 87 million, comprising about 20 percent of the U.S. population.

Who is going to take care of all of the aged people, given the number of small families, divorced couples and working people? Much of the care will be left to the 18,000 nursing homes operating in this country.

Nursing homes did not really begin to develop until after World War II, when the federal government began licensing and regulating them. With the passage of Medicare and medicaid legislation in 1965 that authorized federal reimbursements for these homes, the number of beds soared, and nursing homes became big business, from private sole-proprietorship facilities to corporate chain operations.

Such facilities deal with residents’ needs ranging from rehabilitation to custodial care. Although a host of federal regulations are in place and administered under the U.S. Department of Health and Human Services, state governments are responsible for enforcing compliance with federal and state regulations. Generally, the state’s public health department conducts inspections.

When abuse and neglect occur, it is possible to bring a breach of contract action when residents and their families sign an agreement specifying a certain quality of care. But it is generally under state tort law that nursing home residents and their families appear to find the greatest satisfaction and relief.

In Illinois, the Nursing Home Care Act, 210 ILCS 45/1-101 (2005), deals with such facilities. When it was originally passed in 1979, it was hailed as the most comprehensive legislation in the nation dealing with long-term care. The act explains the conditions necessary to provide adequate long-term care and penalties for failing to meet them, with the most drastic remedy being license revocation and closing the facility.

Although such laws are necessary to protect the elderly, they do little for those who personally suffer harm. It is generally left to negligence standards to compensate those who suffer at the hands of nursing home workers. The courts, though, have made a distinction between professional negligence and ordinary negligence, both of which can occur in a nursing home facility.

For example in Myers v. Heritage Enterprises Inc., 354 Ill.App.3d 241, 820 N.E.2d 604 (4th Dist.2004), a 78-year-old resident of a downstate nursing home fractured both legs when she fell while being transported in a special lift. She died two weeks later, apparently of unrelated causes.

The executor of her estate filed a lawsuit alleging negligent transfer and supervision of the patient under the NHCA, as well as a common law negligence. The trial court instructed the jury, though, that only expert testimony could be used to determine if negligence occurred. "You must not attempt to determine this question from any personal knowledge you have," was part of the court’s instruction under I.P.I. 105.01.

On appeal, however, the court reversed and remanded, holding that the plaintiff was prejudiced by such an instruction. The court found that operation of the lift did not require expert testimony necessitating a professional negligence instruction. Jurors should have been allowed to use their own experience to decide if the nurses’ aides negligently dropped the woman.

In Harris v. Manor Healthcare Corporation, 111 Ill.2d 350, 489 N.E.2d 1374 (1986), the Illinois Supreme Court held that the term "adequate care" was synonymous with "ordinary care" or "reasonable care," thus denoting the use of an ordinary care standard of negligence in proceedings against nursing home attendants.

Illinois defines institutional abuse as, "Any physical or mental injury or sexual assault inflicted on a resident other than by accidental means in a facility," Ill. Admin. Code, Title 77, 300, 330 (1983). Malnutrition, bedsores, improper restraints, scalding in bath water or thermal blanket burns, even food poisoning are some of the institutional abuse that has been witnessed by the residents and their loved ones.

Robert Browning, the 19th century poet, once wrote, "Grow old along with me!/The best is yet to be./The last of life, for which the first was made:/Our times are in His hand."

Life in Illinois’ nursing homes may not live up to Browning’s ideal. It is left to the legal community to at least ensure that a decent quality of life for the elderly is sustained, particularly for those who often cannot take care of themselves.

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Interesting article from the Courant.com about a deal to sell the bankrupt Haven Healthcare nursing-home chain.  Attorney General Richard Blumenthal said that Formation Capital, which owns Genesis HealthCare, notified the state that it was pulling out of an $85 million deal to take over 14 of Haven's homes in Connecticut and 10 in other New England states, without giving a reason.

Formation announced June 12 that it had signed a purchase agreement for the homes, but the company had two weeks to reconsider before the deal was to be finalized in bankruptcy court Thursday.

Many nursing homes across the country are owned by real-estate investment firms and managed by other entities — a form of ownership called a REIT, or a real-estate investment trust. By law, a REIT cannot operate a nursing home, but must hire a licensed provider to do so.

"The former management of Haven is history. We are all committed to a new day for these nursing homes, their residents and their dedicated employees," Blumenthal said.

Blumenthal and officials of the state Department of Social Services said they and the health department will be closely monitoring operations of the Haven homes while the future of the chain remains in limbo.   Occupancy in some Haven homes has fallen off dramatically since the chain declared bankruptcy seven months ago.

Haven — one of the largest chains in the state, with more than 1,800 beds — declared bankruptcy last November in the wake of a series in The Courant detailing its financial troubles and repeated citations for patient-care deficiencies. The company defaulted on millions of dollars in bills for supplies and utilities while its CEO used corporate assets to launch a Nashville recording company and make other personal purchases.

The Department of Social Services had offered Genesis sizable Medicaid rate increases and other incentives to take over the chain, but also had required that Genesis agree to provide detailed financial reports and meet certain staffing standards once it took over operations. 

Blumenthal said Thursday that a wide-ranging investigation of Haven's financial dealings will continue, regardless of the outcome of the sale of the chain.

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Below are excerpts of an interesting article about "Green Houses".  A new approach to taking care of the elderly.  The article is called: "Rising challenger takes on elder-care system" (06/24/08 Wall Street Journal) By Lucette Lagnado

In the spring of 2001, Bill Thomas, dressed in his usual sweat shirt and Birkenstock sandals, entered the buttoned-down halls of the Robert Wood Johnson Foundation.  His message: Nursing homes need to be taken out of business. "It's time to turn out the lights," he declared.

Cautious but intrigued, foundation executives handed Dr. Thomas a modest $300,000 grant several months later. Now the country's fourth-largest philanthropy is throwing its considerable weight behind the 48-year-old physician's vision of "Green Houses," an eight-year-old movement to replace large nursing homes with small, homelike facilities for 10 to 12 residents.   "We want to transform a broken system of care," says Jane Isaacs Lowe, who oversees the foundation's "Vulnerable Populations portfolio." "I don't want to be in a wheelchair in a hallway when I am 85."

The foundation's undertaking represents the most ambitious effort to date to turn a nice idea into a serious challenger to the nation's system of 16,000 nursing homes. To its proponents, Green Houses are nothing less than a revolution that could overthrow what they see as the rigid, impersonal, at times degrading life the elderly can experience at large institutions.

Green Houses face a host of hurdles.  Plus, experts say the concept faces stiff resistance from many parts of the existing nursing-home system. Traditional nursing homes, many of which care for 100 to 200 patients, are predicated on economies of scale -- the larger the home, the cheaper it is to care for each individual resident.

"Robert Wood Johnson is making an important investment to try to make sure there is a sufficient cadre of early adopters of the Green House model -- and research to make sure the model is actually working," says Thomas Hamilton, who oversees nursing-home quality and regulatory issues for the Centers for Medicare & Medicaid Services. He says his agency is trying to coax nursing homes into changing their cultures and adopting more humane, "patient-centered" models such as the Green House.

The $122 billion nursing-home industry arose from the 1965 birth of Medicare and Medicaid, the government health-insurance programs for the elderly and poor that provide billions in government reimbursements. Made up of both not-for-profit and for-profit companies, the industry still generates most of its revenue from Medicaid and Medicare.

Ms. Lowe and her foundation colleagues began to shift that stance after their meeting with Dr. Thomas. A native of upstate New York, Dr. Thomas headed to Massachusetts to get his degree at Harvard Medical School, then returned to work as a doctor in a local nursing home. He says he was troubled by the experience. "I was distressed by the amount of emotional suffering that people were encountering even when they had good medical care," he says.

But it was Dr. Thomas's electric delivery -- officials liken him to an evangelist -- that got the group's attention. "Our energy needs to be around how to replace nursing homes. Not replace the building but replace the idea that older people can be taken away and put into an institution," Dr. Thomas recalls saying. He described his vision of homelike places where elderly residents could gather, dine together and sit before a blazing fire.

In 2003, Ms. Lowe traveled to Tupelo, Miss., where the first Green House had just opened, and says she marveled at how different it was from a well-regarded nursing home she'd previously visited. "Instead of thinking, 'I don't want to be here,' it was, 'How can I move in?'" she recalls.

Rebecca Maust, chief of the Division of Quality Assurance at the Ohio Health Department, says in a statement that the agency "fully supports" person-centered care but that Green Houses have to be on the same lot as the main nursing home to "ensure proper care of residents."

Mr. Hamilton of the Centers for Medicare & Medicaid Services says his agency doesn't think existing rules "represent any serious barriers" to the Green House model. He added that he wants to "maintain open lines of communication" to any parties who believe that a regulation is a barrier.

"There are providers who don't want to change because of the capital investment they've made," adds Larry Minnix, CEO of the American Association of Homes and Services for the Aging, which represents not-for-profits. But he says they need to. "Forty years ago, the paradigm was the 'minihospital' and that is what became the modern American nursing home," Mr. Minnix says. "That is not what is needed now." 

Robert Jenkens, who is spearheading the Green House project at NCB Capital for Robert Wood Johnson, says that some not-for-profits and at least one for-profit believe the model to be financially viable. St. John's Lutheran Ministries in Billings, Mont., operates both a nursing home and some Green Houses. In an internal review, officials found that it cost $192 a day to care for a resident in the traditional nursing home versus $150 a day in their Green Houses.

Based on this "first round" of Green Houses, they believe that it is financially doable, but they are rigorously testing the model and developing software that should help providers determine whether they can handle Green Houses financially.   "Green House belongs to the tradition of finding the better product, of building the better mousetrap," he says.

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NEWS RELEASE

Ken Powers
Media Relations Manager
630-792-5175
kpowers@jointcommission.org

The Joint Commission Announces 2009 National Patient Safety Goals
for Long Term Care Organizations

(OAKBROOK TERRACE, Ill. – June 17, 2008) The Joint Commission today announced the 2009 National Patient Safety Goals and related requirements for accredited long term care organizations. The National Patient Safety Goals promote specific improvements in patient safety by providing health care organizations with proven solutions to persistent patient safety problems. These Goals apply to the more than 15,000 Joint Commission-accredited and -certified health care organizations and programs.

Major changes include a new requirement related to preventing deadly central line-associated bloodstream infections. This addition builds on an existing National Patient Safety Goal to reduce the risk of health care associated infections, and recognizes that patients continue to acquire preventable infections at an alarming rate while receiving health care. The new infection-related requirement has a one-year phase-in period that includes defined milestones, with full implementation expected by January 1, 2010.

“The 2009 National Patient Safety Goals represent ongoing opportunities for improvement that can immediately benefit patients,” says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “By taking action to consistently meet the Goals, health care organizations can substantially improve patient safety in America.”

A revision of the requirements for the existing medication reconciliation Goal is based on feedback obtained from a Medication Reconciliation Summit convened in late 2007 and is included in the 2009 update.

The 2009 Long Term Care National Patient Safety Goals:

Improve the accuracy of resident identification.
· Use at least two resident identifiers when providing care, treatment, and services.

· Prior to the start of any surgical or invasive procedure, individuals involved in the procedure conduct a final verification process, such as a time-out, to confirm the correct resident, procedure and site, using active, not passive, communication techniques.

Improve the effectiveness of communication among caregivers.
· For verbal or telephone orders or for telephone reporting of critical test results, the individual giving the order verifies the complete order or test result by having the person receiving information record and “read-back” the complete order or test result.

· There is a standardized list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization.

· The organization measures, assesses, and, if needed, takes action to improve the timeliness of reporting, and the timeliness of receipt of critical tests and critical results and values by the responsible licensed caregiver.

· The organization implements a standardized approach to hand-off communications, including an opportunity to ask and respond to questions.

Improve the safety of using medications.
· The organization identifies and, at a minimum, annually reviews a list of look-alike/sound-alike medications used in the organization, and takes action to prevent errors involving the interchange of these medications.

· Reduce the likelihood of resident harm associated with the use of anticoagulation therapy. (Note: This requirement applies only to organizations that provide anticoagulation therapy and/or long-term anticoagulation prophylaxis (for example, atrial fibrillation) where the clinical expectation is that the resident’s laboratory values for coagulation will remain outside normal values. This requirement does not apply to routine situations where short-term prophylactic anticoagulation is used for venous thrombo-embolism prevention (for example, related to procedures or hospitalization) and the clinical expectation is that the resident’s laboratory values for coagulation will remain within, or close to, normal values.

Reduce the risk of health care-associated infections.
· Comply with current World Health Organization (WHO) hand hygiene guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.

· Manage as sentinel events all identified cases of unanticipated death or major permanent loss of
function related to a health care associated infection.

· Implement best practices or evidence-based guidelines to prevent central line-associated bloodstream infections. Note: This requirement covers short and long term central venous catheters and PICC lines.

Accurately and completely reconcile medications across the continuum of care.

A process exists for comparing the resident’s current medications with those ordered for the resident while under the care of the organization.
When a resident is referred or transferred from one organization to another, the complete and reconciled list of medications is communicated to the next provider of service and the communication is documented. Alternatively, when a resident leaves the organization’s care directly to his or her home, the complete and reconciled list of medications is provided to the resident’s known primary care provider, or the original referring provider, or a known next provider of service. (Note: When the next provider of service is unknown or when no known formal relationship is planned with a next provider, giving the resident, and family as needed, the list of reconciled medications is sufficient.)
When a resident leaves the organization’s care, a complete and reconciled list of the resident’s medications is provided directly to the resident, and the resident’s family as needed, and the list is explained to the resident and/or family.
In settings where medications are used minimally, or prescribed for a short duration, modified medication reconciliation processes are performed. Note: This requirement does not apply to organizations that do not administer medications. However, it is important for health care organizations to know what types of medications their residents are taking because these medications could affect the care, treatment, and services provided.
Reduce the risk of resident harm resulting from falls.

· The organization implements a fall reduction program that includes an evaluation of the effectiveness of the program.

Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.
· The organization develops and implements protocols for administration of the flu vaccine.

· The organization develops and implements protocols for administration of the pneumococcus vaccine.

· The organization develops and implements protocols to identify new cases of influenza and to manage outbreaks.

Encourage residents’ active involvement in their own care as a resident safety strategy.
· Identify the ways in which the resident and his or her family can report concerns about safety and encourage them to do so.

Prevent health care associated pressure ulcers (decubitus ulcers).
· Assess and periodically reassess each resident’s risk for developing a pressure ulcer (decubitus ulcer) and take action to address any identified risks.

The development, annual review and modification of the National Patient Safety Goals, first introduced in 2003, is overseen by the Sentinel Event Advisory Group, a panel that includes widely recognized patient safety experts, nurses, physicians, pharmacists, risk managers and other professionals who have hands-on experience in addressing patient safety issues in hospitals and other health care settings. Each year, this panel works with The Joint Commission to undertake a systematic review of the literature and available databases to identify potential new Goals and requirements. The Joint Commission also conducts an extensive field review of candidate new Goals and seeks input from practitioners, provider organizations, purchasers, and consumer groups among others. The Joint Commission’s Board of Commissioners approves the Goals and requirements each year. Compliance with the requirements is a condition of continuing accreditation or certification for Joint Commission-accredited and -certified organizations.

The full text of the 2009 National Patient Safety Goals and requirements for all accreditation programs, along with the elements of performance, can be found on The Joint Commission’s website. Compliance with the requirements is a condition of continuing accreditation or certification for Joint Commission-accredited and -certified organizations.

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Mother Jones had an interesting article about Ken Connor, the conservative Christian Republican who testified in support of a bill that would ban the use of mandatory binding arbitration clauses in nursing home contracts. Most nursing homes today, as a condition of admission, force vulnerable elderly people to waive their right to a jury trial. Instead, they must take any complaints about neglect or abuse to a private arbitrator, chosen and paid by the nursing home, in secret proceedings where awards are much lower. The arbitration agreements are often buried in a stack of complicated paperwork, where in some cases, they have been signed by blind people and those suffering from Alzheimer's.

The nursing home arbitration bill should pass overwhelmingly. That's why Republicans really, really don't want to vote for the nursing home bill, and one reason Connor's advocacy is making them squirm.   Connor sues nursing homes for a living. Just last month, Connor won a $2 million verdict against Sunrise Senior Living in California for failing to prevent and care for an elderly woman's fatal bedsores. . As such, Republicans would love to dismiss Connor as just another greedy trial lawyer. But Connor's religious-right bona fides simply make that impossible.

For three years, Connor served as the president of the Family Research Council, a leading social conservative outfit, and became a rock star among the GOP’s evangelical wing when he went to work in 2004 for then-Governor Jeb Bush to defend a Florida law that would have prevented doctors from removing Terri Schiavo's feeding tube. For Republican legislators, Connor has moral authority. He also gives money to many of them, so Republicans have to tolerate him, even as he forces them into a corner where they have to chose between devotion to industry and devotion to God and life.

While the GOP views trial lawyers as its mortal enemies, Connor doesn't see any contradiction between his profession and role as family values crusader. Instead, he sees his lawsuits against nursing homes as an extension of the work he did in the Schiavo case. "Removing the feeding tube, letting Teri Schiavo starve to death," he said in an interview, "I see this all the time with the elderly." Connor believes that the frail elderly are second only to the unborn in their suffering due to what he sees as a prevailing "quality of life" mindset, as opposed to one focused on the sanctity of life. He says he's witnessed bioethicists in Florida argue that if an elderly person suffers from dementia, there would be nothing wrong with hastening his or her demise. "If you call yourself a Christian, you have an obligation to fight for social justice," he says, noting that, "It's much easier to make the case for the elderly than for the unborn." 

He testified about some of his experiences with nursing homes: "All too often, the story is the same: avoidable pressure ulcers (bed sores) penetrating to the bone; wounds with dirty bandages that are infected and foul smelling; patients languishing in urine and feces for hours on end; hollow-eyed residents suffering from avoidable malnutrition, unable to ask for help because their tongues are parched and swollen from preventable dehydration; dirty catheters clogged with crystalline sediment and yellow-green urine in the bag."

Continue Reading...

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Politico's Samuel Loewenberg wrote an article about how high priced lobbyists are attempting to get rid of necessary reforms for nursing home care to improve.

The profitable nursing home industry is mobilizing Washington’s most well-connected lobbyists to fight needed reforms,  Recently state and federal investigators and outside experts have agreed to certain reforms as a gaggle of industry lobbyists plotted strategy.

Among the lobbysts was The Carlyle Group, the politically connected and powerful private equity firm that recently bought Manor Care, one of the nation’s largest nursing home chain, for $6.3 billion.  

“In spite of existing oversight mechanisms, we continue to see examples of horrific treatment of nursing home residents,” testified Lewis Morris, general counsel for the Department of Health and Human Services’ Office of the Inspector General.

The lobbyists are carefully watching the Senate, where legislation could increase the oversight and enforcement of the industry.  It is well documented how deficient the oversight and enforcement of the industry is as evidenced by the recent GAO Report.  The senators are expected to try to attach the legislation to the upcoming Medicare payments package.

The industry lobbyists are fighting provisions to fully disclose ownership of nursing homes.  Why? No one knows. Clearly, families of residents should be able to understand who owns and operates the facility where they place loved ones. 

Additionally, penalties would be increased to as much as $100,000 if a patient is harmed or dies due to poor care. The penalties, which have not been changed in two decades, are now capped at $10,000.

To gird for the increased regulation, the industry is using a half-dozen of Washington’s most politically potent lobbying firms on both sides of the aisle.  “It is going to be pretty much battening down the hatches, because we’re not going to have a fair shake with a Democratic majority,” said a nursing home industry lobbyist who spoke on the condition of anonymity.

Since Carlyle took over Manor Care, some homes have reported significant patient care problems, said SEIU spokeswoman Julie Eisenhardt.   Meanwhile lobbyists for The Carlyle Group are stating that there is no evidence that private equity ownership negatively impacts care.   Both the Government Accountability Office and the Senate Finance Committee are still investigating the negative effect of private equity ownership on nursing home quality.

The issue is at the heart of one of the most controversial parts of the Grassley-Kohl legislation: a requirement that the sometimes-twisted ownership structures of nursing homes be made more transparent.   Congressional staff, experts, and advocates for the elderly say that private equity firms often establish layers in ownership structure as a way to dodge responsibility and legal liability.

And GAO reported how federal government regulators often miss signs of abuse and care deficiencies, ranging from failure to ensure “proper nutrition and hydration and [prevent] pressure sores” to serious deficiencies that could lead to “actual harm and immediate jeopardy.”

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Here is a link to the recent GAO Report that shows a lack of investigation into nursing home neglect and abuse.  The NY Times ran a great article on this report.  Below are some excerpts from that article.

Nursing home inspectors routinely overlook or minimize problems that pose a serious, immediate threat to patients, Congressional investigators say in a new report.   In the report, the investigators from the Government Accountability Office, say they have found widespread “understatement of deficiencies,” including malnutrition, severe bedsores, overuse of prescription medications and abuse of nursing home residents.

The accountability office found that state employees had missed at least one serious deficiency in 15 percent of the inspections checked by federal officials. In nine states, inspectors missed serious problems in more than 25 percent of the surveys analyzed from 2002 to 2007.

The nine states most likely to miss serious deficiencies were Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming, the report said.

“Poor quality of care — worsening pressure sores or untreated weight loss — in a small but unacceptably high number of nursing homes continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said.   Nursing homes must meet federal standards as a condition of participating in Medicaid and Medicare.

Lewis Morris, chief counsel to the inspector general of the Department of Health and Human Services, said he had often been frustrated in trying to identify the owners of nursing homes that provided substandard care.  “We have found nursing home residents who were grossly dehydrated or malnourished,” Mr. Morris said. “We’ve found patients with maggot infestations in wounds and dead flesh. We’ve found residents with broken bones that went unmended.”

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William C. Lhotka of the St. louis Post-dispatch wrote an article about a Judge preventing a nursing home from evicting a resident from a nursing home.  Below is an excerpt of his article:

A judge has barred an Ellisville nursing home from discharging a resident in a billing dispute because of the possible traumatic effects of transferring her to another care facility.  The judge found for the family of Barbara H. Lindsay and against Bethesda Long Term Care Inc. which operates Bethesda Meadow.  The ruling means the nursing home cannot move Lindsay to another nursing home when Bethesda alleged Lindsay's family owed the company past due bills.

Lindsay's son Douglas contended that the bill was erroneous and that his mother was too fragile to move.   Jacqueline Levey, attorney for the Lindsays, argued before Vincent that "any nursing facility wishing to expel an elderly or disabled resident can simply manufacture a series of grossly inaccurate billing statements."

Bethesda lawyer James W. Erwin had contended that some billing errors by Bethesda didn't negate the failure of the Lindsay family to make payments.  On the day before the hearing in October, the Lindsay family paid its bill in full. Nonetheless, the nursing home proceeded with the discharge, said Levey, the family's lawyer.

Vincent cited medical testimony in his order that Barbara Lindsay "is very fragile and has very little strength." The judge said the nursing home provided no evidence that "a safe and orderly discharge could be accomplished."

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Below is an excerpt of an article I recently saw from The Choate News about how California nursing homes used an increase in reimbursements from the State for profit instead of providing adequate care.

Nursing Home Pocket Money Meant For Care
By Jordan Rau

SACRAMENTO, Calif. -- California’s nursing homes pocketed much of the $590 million that state lawmakers provided them to better tend to low-income people, while patient care declined by several key measures, according to a study to be released Tuesday.

A law boosting reimbursements from MediCal, the state’s health-care program for poor people, passed in 2004. By 2006, the first full year the higher rates were in place, average nursing-home revenues from MediCal had increased from $124 a day to $152 per day, according to the study by a team of researchers at the University of California, San Francisco -- but few of the promised improvements for patients or staff had come to pass.

Nursing attention for patients grew, on average, by 3 percent. But the study also found that 144 homes, or 16 percent, did not meet the state’s minimum staffing standard.

Average wages for nursing assistants increased from $10.61 an hour to $11.32, not quite enough to keep pace with inflation, the study said.   Turnover among nurses grew slightly worse, with nearly 7 in 10 leaving their jobs that year.

The amount nursing homes spent on direct patient care actually decreased by 3.6 percent, according to the study. Substantiated complaints of patient mistreatment increased by 38 percent. State and federal regulators cited homes for 6 percent more violations.

“They got so much money, they should have been able to do something,” said the study’s lead author, Charlene Harrington, a UCSF professor and nationally recognized authority on nursing homes.   “The fact that they let the nursing-assistant wages actually decline with inflation, I think there’s no excuse for that,” Harrington said. “They’re the bulk of the workers and they’re the lowest paid.”

The higher reimbursement rates were pushed through the Legislature in the final two weeks of its 2004 session by a powerful alliance between the nursing-home industry and Service Employees International Union, which represents many health-care workers.

At the time, several nursing-home advocates objected that the measure lacked sufficient safeguards to ensure that the money went to patient care.

Along with more money, the new law changed the way facilities were reimbursed from a flat fee for each patient to one based on how much the homes spent on workers, patients and the physical plant. Supporters pledged that the change would reward homes that hired more nurses and paid them better.

The average nursing home netted $248,047 in 2006, a 233 percent increase from 2004, the study said.   The study found some areas where nursing-home spending did increase substantially.

For example, administrators’ wages rose by 13 percent, and the pay for licensed nurses -- who have more training than assistants -- grew by 9 percent.

Nonprofit nursing homes raised their wages more than for-profit homes. Still, said Michael Connors of California Advocates for Nursing Home Reform, a patient watchdog group, “to a great degree, no one knows where the money went and how it was used. What’s clear is it hasn’t been used for beneficial effects on residents, which is appalling.”

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Here is an article from Long Term Living online editor John Oberlin that indicates that the economic slowdown will not affect the profits by the nursing home industry.  Cambridge Chairman Jeffrey A. Davis points out that all components of the senior housing sector appear to be in good shape, with nursing homes, assisted living, and independent living facilities all at their highest occupancy levels in years

Although the economy apparently is at a tipping point, the outlook for the senior housing/healthcare industry remains remarkably upbeat, one industry expert maintains.

"While no industry is completely recession-proof, owners and operators of senior housing/healthcare properties are better positioned to deal with an economic downturn than they've been at other periods in the past," believes Jeffrey A. Davis, chairman of Cambridge Realty Capital Companies, a senior/healthcare debt and equity financing firm.

"Historically, the pattern has been for the industry to go through debilitating boom/bust cycles. However, at this time, there's no over-building and occupancy levels for all product types are high," he observes.

Davis points out that all components of the senior housing sector appear to be in good shape, with nursing homes, assisted living, and independent living facilities all at their highest occupancy levels in years.

"This time around, there has been significant restraint regarding new construction. Generally speaking, management appears to be more enlightened in this regard and consumers more aware of the expanding range of products available to them. Even if the economy tanks, the industry will not be as vulnerable as some other segments of the commercial real estate market because there hasn't been an artificial demand component working against sound economic judgment," he said.

"Going forward, capital will continue to be available but more constrained in 2008. The crisis in confidence has impacted various lenders in different ways, and underwriting criteria has become more stringent across-the-board.

"But credit will be available from sources attracted to the industry by its long-term outlook. Investors and commercial lenders notice that demographics for the industry continue to move in a positive direction, and that the product that has emerged in the marketplace today has a much broader appeal to users than it did 25 years ago," he said.

HUD has emerged as the preeminent lender of choice for qualified borrowers in the skilled nursing home and assisted living segments and continues to solidify its role as a capital provider to under-served markets. But capital will also be coming from a variety of other sources, including Fannie Mae, Freddie Mac, commercial banks, insurance companies, private equity firms, and credit companies, he noted.

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Oklahoma Center for Consumer & Patient Safety
PO Box 4481, Tulsa, OK 74159-0481

FOR IMMEDIATE RELEASE:

Contact: Hugh M. Robert, Ex Dir 918-850-0293 hugh@okccps.org

April 7, 2008

HOUSE COMMITTEE KILLS NURSING HOME INSURANCE REQUIREMENT:

REPLACES BILL TO FAVOR COMMITTEE CHAIR

Tulsa, OK – The Public Health Committee in the Oklahoma House of Representatives considered the amended version of the bi-partisan approved Senate Bill 1549 this morning. Just minutes before the committee meeting was scheduled to begin, Representative Cox, the owner of several nursing homes, submitted a committee substitute which stripped out the insurance requirement. The committee members voted 10-9 to consider the committee substitute, falling one vote short of being able to hear the bill in the form already approved by the Senate.

“It is sad that Dr. Cox put his personal financial interest in front of requiring nursing homes be financially responsible,” said Hugh M. Robert, Executive Director of the Oklahoma Center for Consumer and Patient Safety. Robert went on to say “the Oklahoma Senate had overwhelmingly supported the amended bill and Dr. Cox, who purportedly operates his nursing homes without insurance, today showed his personal financial interest is more important to him than protecting his constituents or the citizens of the State of Oklahoma.”

The amended bill would have required nursing home operators to prove they have sufficient assets to cover claims of resident abuse or neglect. If the nursing home operator fails to keep sufficient assets and does not carry liability insurance the officers, directors and shareholders of the nursing home operator would be personally liable to a nursing home resident or their family when someone is abused or neglected.

One reason Dr. Cox as well as the nursing home lobby has cited for not carrying insurance is that the Medicaid reimbursement levels not being high enough to provide the owners with large profits and pay for insurance. However, this does not take into account the private pay residents and if the issue is with reimbursement rates, then Dr. Cox, in his capacity as a representative should work on reimbursement rates, not blocking a resident or family of a resident from holding responsible a nursing home who abuses or neglects a loved one.

If a nursing home resident is neglected or abused they should have a remedy. Robert comments “we require people who drive cars to carry mandatory insurance, why should nursing homes be any different.” “Forcing nursing home operators to show they are financially sound in order to have a license to take care of our elderly citizens just makes common sense, especially with the growing elderly population” Robert says. Most nursing home operators are for profit and carrying liability insurance is a legitimate cost of doing business. A nursing home does not have to choose between providing good care and being financially responsible, they should be required to do both.

About the Oklahoma Center for Consumer and Patient Safety- Please call 800-994-6025 or visit www.okccps.org.

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Below is an excerpt from a great article from Dallas News about family councils in Texas.  The relatives of Texas nursing home residents have discovered there's strength in numbers. Emboldened by a new state law, they've begun to organize more "family councils" at their nursing homes to advocate for better care.

"My mother was the one who taught me how to stand up and speak out, so it's only fitting that I now step in for her," said Daisy Kincheloe, who knew she had to do something after her elderly mother fell at Doctors Healthcare Center in North Dallas.  Her mother's accident was the last straw. Before that, she had discovered other problems that convinced her that some staff members weren't paying enough attention.

Ms. Kincheloe and other families at Doctors have just formed the group to give each other moral support, act as added sets of eyes and ears around the nursing home, and bring grievances to the administration's attention. By presenting a united front, family councils have persuaded nursing homes to respond more quickly to residents' call buttons, improve the meals and even hire more staff.  Family councils are enjoying renewed attention nationwide because many of their newer leaders are baby boomers, whose generation is known for its activism.

Though administrators occasionally resist the councils at first, a growing number say they welcome the groups because they encourage family participation and accountability from staff.

Many families hesitate to bring up problems because they're afraid the nursing home staff will retaliate against their relatives. Others complain but find their grievances fall on deaf ears.   A family council can add weight to a complaint, advocates say.

HOW TO ORGANIZE A FAMILY COUNCIL

1. Determine the need. As few as two or three families can organize a council.

2. Advise the administrator. By law, nursing homes must provide private meeting space for councils.

3. Notify other families. Meeting announcements can be posted on bulletin boards. Administrators may also offer to mail notices.

4. Ask advocacy groups and the local ombudsman for help. Advocates and the state ombudsman program's local representative can explain nursing home residents' rights.

5. Hold your first meeting. Discuss the council's purpose, ask the ombudsman to talk about the grievance process and invite the administrator to speak.

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There is a great article about the use of the game Wii to help residents with socialization and physical therapyin nursing homes.  Wii-hab is the name of the game sweeping nursing homes across the region.
Morrell Nursing & Rehab Center in Hartsville and Bethea Baptist in Darlington are among the long-term care facilities taking part in the craze, much to the delight of their residents.  The new Wii-hab program uses the Nintendo Wii to promote exercise at the facility.   

The favorite game is Wii bowling, because it allows the residents to exercise upper body despite physical  limitations.  Residents and staff alike gather in the center’s sunny activities room to both play and watch others play such Wii games as bowling, tennis, baseball and boxing.

Mary Etheredge, activities director at Morrell, is the person responsible for bringing the program to all three of Wilson Senior Care’s facilities in the Pee Dee. She said so far, the program has been a great success.  Etheredge said the biggest challenge so far has been getting the male residents to participate.  The exercise from the Wii-hab is deceptively easy for many of the residents, Etheredge said, almost tricking them into doing rehab to make their daily lives easier.

“When they’re doing this, they really don’t realize how much they are moving,” she said. “It has them concentrating. They have to watch their eye and hand movement. It really works.”
While the tournament was going on, residents and employees gathered around Hopkins and Woodham to cheer them on with yells and clapping.

Etheredge said that sort of involvement has become almost commonplace since the Wii-hab program began at the facility. She said the Wii-hab program has made a difference in the quality of life for residents and it’s a change she plans on keeping around for a long time.

Hopefully this will become standard practice at other nursing homes.

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Randy Ellis staff writer for NewsOk.com has a sad story about a neglected resident who did not get questions or compensation because the nursing home had no assets and no liability insurance.  Below are excerpts of the story:

The story refers to a family who received a telephone call that their mother had been injured at The Gardens nursing home in Sapulpa. Hospital X-rays revealed her mother had suffered spiral fractures to both legs.  Since that type of injury often is caused by abuse or neglect, the family sued the nursing home to get answers about what happened.  However, the nursing home had no medical liability insurance coverage. 

The number of nursing homes that have dropped medical liability insurance coverage has skyrocketed in recent years. There are now at least 56 uninsured homes with 6,621 beds, according to the Tulsa-based Oklahoma Center for Consumer & Patient Safety.
"Based on information provided to the Center, over 20 percent of the beds in Oklahoma are in nursing homes that refuse to carry insurance,” said Hugh M. Robert, executive director of the nonprofit group. "A state study last year speculated the number may be as high as 65 percent.”

Legislation introduced by Sen. Richard Lerblance, D-Hartshorne, would require nursing homes either to carry medical liability insurance or prove they have sufficient assets to pay substantial damages if they are found responsible for injuries caused by abuse or neglect.  It is difficult for consumers to discover that information on their own because nursing home owners often play a "corporate shell game."

One woman had maggots crawling out of her air cast because employees at her Oklahoma City nursing home had not cleaned beneath it and open pressure sores had developed. An Edmond nursing home patient was left on a bed pan so long her tail bone stuck to it, and a woman at a Frederick nursing home died after becoming so dehydrated that her tongue stuck to the roof of her mouth, attorneys said.

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 McKnight's has an article about  the average price paid per bed for skilled nursing facilities hitting a new record in 2007. The average of $55,200 was 6% higher compared with the year before and 75% more than the notable low of 2003, according to analysis results from research firm Irving Levin Associates.

As more investment groups own long-term care properties, valuations and loan volume in the sector soared to record highs. The median SNF bed price leaped 15% in 2007 buoyed by billion-dollar deals involving major nursing home chains going private.

The average sales price for assisted living units also hit a new high $159,100 in 2007, 20% higher than the year before. Independent living unit prices also rose 20% in 2007, to $174,500 per unit, another record, according to the report.

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Connecticut Attorney General Richard Blumenthal wrote an editorial about the nursing home industry.  We have included it below.

 Recent revelations of shameless self-dealing, massive mismanagement and substandard care at one of the state's largest nursing home chains, Haven Healthcare, have rightly shocked the public. Haven, which operates 15 nursing homes in the state, received tens of millions in taxpayer dollars, but often failed to pay its medical and other suppliers, even at times its utility bills.

When it came to patient care, managers constantly cut corners, endangering residents' health and well-being. Adding insult to injury, Haven CEO Ray Termini improperly diverted money to fund his fantasy of becoming a country music mogul. Termini's name for his failed label — Category Five —proved prescient: His mismanagement devastated Haven like a Category 5 hurricane.

After The Courant broke this story, causing Haven to seek bankruptcy protection, my office successfully sought appointment of a chief restructuring officer who is currently supervising the chain's operations until a responsible buyer is found and a patient care officer has stabilized and improved care at the facilities. This remedy required a Herculean legal battle, which took tremendous time and determination from my office, as well as the court. In addition to wasting state tax dollars and endangering residents, this abysmal episode exposed severe deficiencies in state oversight of nursing homes.

Haven's secret self-serving diversion of scarce resources exemplifies the dark side of nursing home consolidation, leading to a fiscal debacle and endangering patient well-being. As nursing homes are swallowed by corporate chains and conglomerates such as Haven, state supervision becomes more difficult. Byzantine corporate constellations — like the 45 interlocking entities established by Haven's owners — conceal and confuse, frustrating accountability and oversight. Such improper practices must be prevented, not just punished.

The state must demand more financial disclosure and transparency to prevent plunder of nursing home assets. To forestall future bankruptcies or insolvencies — as happened to Haven — the state should impose expanded auditing and reporting requirements, prohibitions on bleeding or abuse of resources, accountability of landlords and other measures that safeguard public dollars and cents — the lifeblood of patient care.

Symptoms of fiscal crisis should immediately land nursing homes on a watch list with the same stringent monitoring and scrutiny as a patient in intensive care, and with prompt state intervention when necessary. I have proposed a package of reforms to guard against abuses, better protect patients and ensure that state tax dollars are properly spent.

My proposals include:

 • Empower the state comptroller to monitor and review nursing home finances through regular forensic financial audits of nursing homes and their owners. The comptroller could subpoena records, compel testimony and review financial information of nursing home operators and their affiliates.

 • Provide for a court-appointed receiver upon a finding of gross financial mismanagement. Currently, a receiver may only be appointed if financial mismanagement threatens patient care — a higher bar that hindered our ability to obtain a receiver for Haven sooner.    

 • Cap management fees and rental payments that nursing homes pay to related entities at the amount allowed under Medicaid reimbursement rates and prohibit use of nursing home assets as collateral for loans unrelated to operations. This step will prevent nursing home affiliates from soaking taxpayers through sweetheart contracts with related management or landlord companies.

• Require a minimum level of malpractice and liability insurance coverage for nursing home owners and management companies.                 

• Clarify and strengthen the state Department of Public Health's authority to regulate and approve nursing ownership structures and agreements. As happened with Haven, nursing home operators too often disperse ownership among numerous limited liability corporations, affiliates, subsidiaries and wholly owned partnerships — hindering efforts to identify, evaluate and hold accountable a home's real owner.

 • Make landlords legally responsible for nursing home repairs and maintenance. The health department should also be authorized to seek appointment of a building monitor to do repairs and divert rent to pay for the work if the home's owner fails or refuses to do it.

Massive nursing home conglomerates like Haven Healthcare are leaving mountains of financial ruin after squandering massive public funding, imperiling patient care and safety. The regulatory landscape of nursing homes in Connecticut must be reformed to halt these abuses.

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A newly released poll from Zogby International shows that 63% of respondents oppose President Bush's proposed nursing home Medicare cuts.

Also, 61% of those surveyed would be less likely to vote to re-elect their representative in Congress if he or she voted for the president's plan containing Medicare reductions. Bush's proposed budget would slash $24 billion to the nursing home benefit over five years. Zogby conducted the poll for the American Health Care Association, a major lobbying group for the nursing home industry.

Other results of the poll: 50% of respondents say that any nursing home benefit cuts would have "a negative impact on the quality of care for seniors" and 73% say they would support a presidential candidate who will not reduce Medicare funding for nursing homes.

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Brandunson.com has an article about Extendicare REIT reporting fourth quarter profits of $10.5 million.  Revenue in the quarter totalled $469.7 million, up from $453 million.

Extendicare REIT, through its owned subsidiaries, operates 269 nursing and assisted living facilities in North America as well as medical specialty services.

For the full year, Extendicare earned $70.4 million or $1 per diluted share on $1.8 billion in revenue. That compared with a loss of $35.7 million or 53 cents per diluted share on $1.73 billion in revenue in 2006. Shares in Extendicare, which released its results after the close of markets, were down 18 cents at $11.30 on the Toronto Stock Exchange.

This shows that nursing homes are very profitable even during bad economic times.  It also shows there is no need for ridiculous caps on damages.

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KDBC in Texas ran a story about a new study that suggests the overuse of antibiotics in dementia patients contributes to drug-resistant germs.   In the study published in Archives of Internal Medicine, more than 200 people with advanced dementia were followed for 18 months. Almost half died before the study finished.  Researchers found 42% received antibiotics within two weeks of their deaths.

Antibiotic overuse spurs on the potentially fatal drug-resistant bugs like MRSA.  Past studies have suggested that nursing homes are favored stomping grounds for the super germs.   The study's co-author says doctors should discuss antibiotics with family, just as they would discuss placing a feeding tube.

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The Tennessean has a great editorial about the legislation that will protect nursing homes who abuse and neglect residents.  Below is a summary of the editorial.

Nursing home operators are begging the General Assembly to grant them special protections from lawsuits that might be filed by residents who are seriously wronged under their care.  What the owners want is a law that would allow nursing homes to force residents to waive their constitutional right to a jury trial and sign arbitration agreements as a prerequisite for being admitted, and they want caps on how much money a jury could award to a resident in a case against the nursing home.

This effort by the nursing home industry takes a lot of nerve. The state suspended admissions at 22 nursing homes in 2007, which was twice as many as in the previous year and three times the amount in 2005. Hundreds of residents were displaced last year because of serious health and safety violations that caused those homes to lose federal funds. Yet in this environment, the nursing home industry wants special protection from lawsuits. 

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McKnight's website has an article about Medicare overpayments (i.e. fraud) to nursing homes and estimate that the amount could be $130 million. Where did all the money go?

The federal investigation into these overpayments state that the Medicare program might have paid too much for hospital and laboratory services including double payments for services.  As a result of its findings, OIG recommended (not ordered) that the Centers for Medicare & Medicaid Services instruct payment contractors to "re-examine" records for overpayments and then move to recover them where appropriate. It also suggested CMS test and refine payment system protocols designed to identify such overpayments.
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The full audit report is available at http://www.oig.hhs.gov/oas/reports/region1/10600503.pdf.

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 KSPR News has an article about a nursing home in Kansas that has introduced the video game Nintendo Wii to the residents.  This assists them in mobility, activity, and social interaction.  The activities director says a group of nursing home residents stay young by playing a game meant for their grandkids.  The activity room at the Ozark Nursing and Care Center is packed when it’s time for Wii.   When they play Wii, a light weight controller allows them to play a game they normally couldn't.   There are more than physical benefits.  It gives the residents a sense of life outside the skilled nursing center.  

 The activities director says they're sticking with bowling for now because it’s the easiest. They'd like to slowly introduce boxing and Guitar Hero. I hope this becomes universal in all nursing homes.

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Washington Post has a great article by Marie-Therese Connolly about demographics and elderly abuse.  Ms. Connolly worked at the DOJ and has years of experience with the nursing home industry.  Below are some excerpts.

As though declining health, impending mortality and other challenges weren't hard enough, too often old age is also plagued by abuse, neglect and exploitation.

Science has extended our lives dramatically: In 1900, Americans' average life expectancy was 47. By 2000, it was 77, and it's still rising.  Estimates of the prevalence of elder abuse vary wildly, but by some reports there could be up to 5 million cases a year, with 84 percent going unreported. All other factors being equal, victims of even relatively minor mistreatment are three times more likely to die prematurely than those who are not victimized.

Furthermore, our nation is in the midst of three seismic demographic shifts that will put seniors at even greater risk for mistreatment. Older people are living longer, until they're frailer and more vulnerable. They are increasingly alone in old age, given that families are smaller and more geographically and emotionally dispersed. And the pool of potential caregivers is aging and shrinking. We need 30,000 geriatricians: We have only 9,000.

Neglect may sound more benign than abuse, but it usually lasts longer, is harder to prove and prosecute, and can be just as lethal.   Thirty percent of seriously ill elders surveyed have told researchers that they would rather die than go to a nursing home.  But while neglect of one person is tragic, systemic neglect by a facility or chain housing numerous residents can be catastrophic.

Facility owners may extract millions in profits, leaving insufficient funds to care for residents. Insulated by corporate structure, casting blame on facility staff, they are rarely held accountable.  But the news about staffing, the most critical factor in the quality of long-term care, is bleak: A government study in 2002 concluded that more than half of the nation's nursing homes are understaffed at levels that harm residents. Nursing homes receive $80 billion from Medicare and Medicaid annually to care for 1.5 million residents.  Yet not a single federal employee works on elder abuse issues full-time.

Marie-Therese Connolly, a fellow at the Woodrow Wilson International Center for Scholars, is former coordinator of the Department of Justice's Elder Justice and Nursing Home Initiative.

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The Kansas City Star has an article about a study from the National Senior Citizens Law Center discussing clauses in nursing home agreements that violate the law.  Some admission agreements skirt state and federal laws, misleading consumers about the care they can expect and inducing them to sign away critical consumer protections.  Advocates for the elderly said the study raised serious questions about how some nursing homes operate.

The National Senior Citizens Law Center, a Washington-based nonprofit legal advocacy group for seniors and elder-care lawyers, reviewed 175 admission agreements voluntarily provided by nursing homes. The study found agreements which improperly limited a nursing home’s obligations. Others allowed discharges for vague reasons, or stuck relatives with bills they legally didn’t owe.

Toby S. Edelman, a spokesman for the Center for Medicare Advocacy in Washington, said similar studies in other states also show “ongoing concerns” with nursing home agreements.

The Missouri study found that nursing homes protect themselves by persuading seniors to waive their right to a jury trial. In 18 percent of the agreements, seniors were required to submit a dispute to arbitration, rather than sue in court.   Trial lawyers contend they have successfully fought the provisions in court as unconstitutional and unenforceable in health-care cases.

The study contends the agreements also thwart federal law by inserting provisions making it easier to evict residents. Federal law sets out six conditions that justify evicting a resident.

Carlson, the study’s author, said that under the federal reform law nursing homes cannot require a relative or a friend to become financially liable for nursing home expenses. Yet, the study found that 19 percent of the admission agreements required a financial guarantee “in direct violation” of federal law.   Such “co-guarantor clauses” are becoming more common.

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Foxbusines.com has a good article about the difficulty the government has in evaluating funding levels for Medicaid.  The article insists that an expansive view of nursing homes industry is needed to determine funding needs.

The Bush Administration's FY 2009 budget will include no Medicare funding update to help care for the growing number of seniors who need high acuity nursing home care.  The Alliance for Quality Nursing Home Care will work to demonstrate that Medicare funding decisions can be accurately determined only by taking a more expansive, complete view of the industry's operating environment. 

This White House has often cited the work of the Medicare Payment Advisory Commission (MedPAC).   Alan G. Rosenbloom, President of the Alliance, stated, "On behalf of nursing home patients and the hundreds of thousands of caregivers who serve them, we are disappointed that again, MedPAC's flawed funding policy guidance is being adopted, and superseding the economic realities experienced by providers in the long term care marketplace.  By failing to consider the substantial Medicaid payment shortfalls to nursing homes in formulating its recommendations, MedPAC provides the Administration, Congress and the public a flawed basis upon which to assess the funding landscape, and to ultimately determine the best policy." 

Medicare funding is important when states are cutting Mediciad to balance their budgets. 

SOURCE The Alliance for Quality Nursing Home Care

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So its time for another one of my little rants.  There's money to be made in the nursing home business, just like there's money to be made in the assisted living business.  However, do you suppose the people actually doing the work are making the money?  If you said "no", you're right. 

I ran across an article about Atria Senior Living, which is owned by a investment fund affiliated with Lazard, a large Wall Street firm.   Reportedly, the CEO of Lazard earned nearly $23 million in 2006 and is worth more than $2 billion.   Want to know how much the employees on the floor at Atria make?  Try $8 - $10 an hour. 

The employees of several Atria facilities decided to join together to unionize, but Atria and Lazard apparently began threatening and intimidating the workers not to unite.   There are so many victims here - residents that probably don't get the quality of care they deserve, due to short staffing, or high turnover which leads to inconsistent care; and of course employees who are out there hands on caring for elderly residents and receiving "peanuts" in return.

What's wrong with this picture?  When do we say 1) the elderly (our mothers, fathers, grandparents) are more important than million dollar salaries and 2) the people that choose to be their caregivers should be adequately compensated for it.

I'm not saying that CEO's don't work.  I was raised by one, and he still works hard every day.  I am saying that people deserve to be compensated for caring for our family members.  I am saying that nursing homes and assisted living facilities cost thousands a month to reside there.  A great deal of what you're paying for is someone to care for you.  Those caregivers should be compensated accordingly.

For more information, visit www.improveassistedliving.org.

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The News & Observer of Raleigh has an interseting article about the "new philosophy" of limiting or preventing nursing home residents from being in a wheelchair as long as the resident wants.

The article argues that older people's health, mobility and self-image can suffer from too much time in wheelchairs. More than 24,000 North Carolina nursing home residents - about two-thirds of the total population - use wheelchairs as their main means of getting around.   

Ways to limit unnecessary wheelchair use are part of a movement that gives priority to the well-being of residents and their caregivers, above the functions of the nursing home or convenience of the staff.

The Midwest-based group called GROW - Get Residents Out of Wheelchairs - has taken up the cause on a national level. The nonprofit urges nursing homes to help residents use regular chairs, couches, recliners when sitting "is considered the norm and socially accepted." That includes for meals, TV watching, socializing with family and friends, and resting when tired.

Advocates acknowledge that wheelchairs have their uses for certain residents at certain times.
Advocates and academics say the downsides to spending too much time in a wheelchair are varied, but specific. They include a greater chance of pressure sores, significant discomfort and physical strain from operating chairs.

In addition, people in wheelchairs can be perceived as less able and are even spoken to differently in what becomes a self-perpetuating cycle of helplessness. Perhaps most importantly, loss of mobility can begin within a few days if someone starts using a wheelchair instead of walking.

Solutions are readily available in concept, but harder in reality. The GROW Coalition wants a requirement that nursing homes carry out a resident assessment before placing anyone in a wheelchair. In addition, lowered staffing ratios would let a center's caregiver take more time with slow-moving residents.

Easier access to meals and other services should mean that more North Carolina nursing-home residents will be able to stay healthy and mobile.

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I realize that this post might be a bit off topic but it shows the arrogance of insurance companies and their contempt and disdain for the rule of law.  Nursing home attorneys routinely see this when the insurance companies refuse to provide nursing home records or when they state an elderly resident's life is not worth much because "they were already going to die" or when they blame neglect on resident complaince.

Allstate Insurance Co. told a judge that they refuse to produce key records to the Court no matter how much the Court fines them.  Judge Michael Manners has already fined them $25,000 a day since mid September — a total of $2.4 million and growing.

Last month the Missouri Supreme Court ordered the documents produced. At issue are the so-called McKinsey documents which show how Allstate set up a claims scheme in the 1990s that shortchanges clients while earning the insurance company huge profits.

Allstate still refuses to disclose the damaging documents.

The case stems from a car wreck seven years ago on Interstate 70. Allstate client Paul Aldridge of Hawaii ran into the back of a truck and severely injured the driver. He is suing Allstate for bad faith for refusing to pay the claim for years.

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Here is an interesting article about attorney Ken Connor's appearance for an advocacy group for nursing home reform.  The seminar was titled "Nursing Homes: A Failed Experiment,".  Connor's appearance was sponsored by the advocacy group Kentuckians for Nursing Home Reform.

Connor said he classified nursing homes as "a failed experiment" because the current system puts the economics of the provider ahead of the life, health and safety of the residents.

"In other words, they put profit over people; they put revenue over residents," he said.

To increase profit, Connor said, staffing is cut. And some nursing homes are run by businessmen who have never been doctors or nurses and don't have any expertise in the medical field. They are, however, good at making money.

It's important for people to be educated about this issue -- to know what to do if they are confronted with a problem and know where to file a complaint. It's also good to know where to find support.

Connor urged the crowd to pay attention to signs such as pressure ulcers, infections, urine and feces-stained bed linen and foul odors. Also, the hollow eyes and parched tongues of loved ones display the lack of time devoted to them.

Connor said nursing home problems are pervasive throughout the country.   "Corral your congressmen and senators and make them understand the breadth of the problem," he said.

Kentuckians for Nursing Home Reform work to change state law so criminal background checks and random drug tests are required for all nursing home employees. They are fighting to ensure there is a minimum staffing standard.

Kentucky has cited about one in four nursing homes for serious deficiencies that caused "actual harm" or "immediate jeopardy". 

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The headquarters of The Carlyle Group, a Wall Street Investment corporation that made our blog a few weeks ago when we wrote about its involvement with Habana Health Care Center (see Wall Street and Nursing Homes? and Nursing Home Profits), was the site of a demonstration Monday, October 22nd by nursing home advocates.  The Carlyle Group is in the process of taking over Manor Care Inc., a Toledo, Ohio-based nursing home chain with facilities across the country.  Manor Care has several facilities in South Carolina.  

The Washington Business Journal reports that the demonstration was organized by SEIU Healthcare, a health care workers union, and it's purpose was to express worries caregivers and advocates have about the quality of care residents will receive after the the takeover as well as the status of jobs within the facilities.  As we blogged in previous articles mentioning The Carlyle Group, there is much data to support the fact that staffing numbers are cut and care quality goes down when Carlyle is involved.

On Monday, Carlyle made a pledge to quality care at Manor Care facilities saying that education, training, and staffing levels would ensue proper clinical care and all federal and state regulations would be met.  A Carlyle higher-up stated that "Manor Care is poised to become an even stronger health care provider under Carlyle's ownership." 

A statement released by Carlyle said the acquisition of Manor Care is expected to be completed by the end of November.  I suppose only time will tell if Carlyle will uphold their promise to provide quality care to the residents of the former Manor Care facilities.  A statem