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

Mcknight's had a recent article about the changes to the CMS ranking website.  The Centers for Medicare & Medicaid Services has announced a number of updates to its Web site. These include new information about the Five-Star rating system for nursing homes, which became available Thursday, May 28.

Five-Star provider preview reports were released May 20. Nursing home providers can access that information through the Minimum Data Set (MDS) State Welcome pages that are available at the state servers for the submission of MDS data, according to CMS.

May's Five-Star data was added to the Nursing Home Compare Web site on May 28. For more information, visit www.medicare.gov/NHcompare.

CMS has also updated the information under its FAQ section of the Recovery Audit Contractor (RAC) portion of its Web site. On May 19, CMS added answers to questions such as "Why is CMS using recovery audit contractors?" and "Who should providers contact with questions concerning recovery audit contractor communications?" For more information, visit www.cms.hhs.gov/RAC.

 

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Regency Nursing and Rehabilitation Centers Inc. nursing home chain will pay the United States $4 million for submitting false claims to Medicare and the Texas Medicaid program, the Justice Department and the U.S. Attorney's Office for the Southern District of Texas announced today. The Victoria, Texas-based chain currently owns and operates 24 nursing home facilities located through the state.  The amount they stole it undetermined.  The charges included false hours and payment for services not rendered to residents.

The False Claims Act settlement resolves allegations that Regency submitted claims for reimbursement to Medicare and Medicaid for rehabilitation and skilled nursing services that were not reimbursable because the nursing home residents were not qualified for the services, the services were not medically necessary, or they were not supported by adequate documentation.

"Nursing home providers participating in Medicare should be on notice that taxpayers will not absorb the costs of improper or false billings submitted to the government and that the Department of Justice will take action against them for submitting such claims," said Tony West, Assistant Attorney General for the Department's Civil Division.

 

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People always ask us why DHEC and other enforcement agencies don't fine facilities who neglect and abuse residents.  There is no one explanation.  Lack of enforcement tools.  Lack of qualified investigators.  Nursing home lobbying and campaign contributions.  Lack of media scrutiny.  I saw an article recently in the Journal Star discussing the limits placed on fines and the importance of monetary fines on quality of care and deterrence.  

The article starts with a simple proposition:  "When a nursing home resident's minor injury is left untreated and progresses to a major infection that ultimately kills her, the facility responsible should pay a stiff price.  When one resident beats another in a nursing home cafeteria because there's no staff member there to stop it, or when a male resident's catheter isn't checked and he gets a serious infection that still has him hospitalized, or when an octogenarian slides out of her wheelchair and is found dead with its seatbelt around her neck because nobody is watching, there ought to be fines that send a message that that's intolerable. And when a resident who takes a tumble complains of dizziness and head pain only to be told her problem will get checked out at an eye exam the next day, there ought to be strict accountability - especially when she ends up dying that next day."

That seems pretty straightforward and full of common sense but how do you decide what is a fair and reasonable fine?  Most states limit the amount of fines that a facility must pay.

A recent  ruling from a judge held that the Illinois Department of Public Health's is limited in fine amounts because State law appears to limit the fines the state can levy for these violations to $10,000 per incident.  The Legislature should amend state law to permit higher fines for abuse and/or neglect. The penalties must be severe enough that negligent nursing home operators will improve the conditions.

The article ends with some basic truths:  Most facilities are understaffed or suffering from burn out.  "Many homes don't staff above the minimal level required by the government, and the difference is often readily apparent. Adding to the problem is the high turnover rate in a workplace that can pay poorly yet require phenomenal dedication in bleak conditions. It's often worse in troubled facilities. It's a tough and trying job in the best of situations."

The residents of nursing homes are society's most vulnerable. They deserve a dignified and safe environment in which to live.   Increased fines, additional investigators, and improved staffing requirements would go a long way in providing the elderly and infirmed the care they need.

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Lexington Herald-Leader had an article about nursing homes that caused at least 6 deaths due to their ignorance and negligence.  Incredible. State investigators have cited 4 nursing homes for failing to perform lifesaving measures on residents who had requested that they be resuscitated.

The errors alleged by the state provide ammunition for those who are pushing for a new law or regulation that would mean all nursing homes would use a purple wristband to identify residents who had signed a do not resuscitate — or DNR — order.

Kentucky has no uniform regulations regarding how to inform staff members of DNR orders at the bedside at nursing homes or hospitals.   Three different groups of nursing home and hospital officials are meeting in the next several weeks to determine whether Kentucky should join other states that have adopted a color-coded system.

Five of the six facilities sanctioned received Type A citations, the most serious the state can give. In all six cases, the individuals died.

■ Kenton Healthcare in Lexington was cited in September 2007 after the staff allegedly did not initiate lifesaving measures on a resident despite a doctor's orders that everything possible be done to save the patient.

■ Hillcrest Health Care Center in Owensboro was cited in December 2008 after cardiovascular pulmonary resuscitation was not performed on a resident who wanted to be resuscitated.

■ In April 2007, staff members at Christian Health Center in Bowling Green did not immediately resuscitate a resident, despite a doctor's orders that lifesaving measures should be used.

Staff members told state investigators that the facility did not have a system that allowed immediate access to the code status of a resident.

■ Woodland Oaks Nursing Home in Ashland is appealing a citation it received in January. Officials there deny failing to perform CPR on a dying patient who had requested lifesaving measures.

■ On the other end of the spectrum, Green Meadows Health Care in Mount Washington received a citation in March 2008 for trying to revive a resident who had signed a DNR order. Green Meadows officials did not return a telephone call seeking comment.

■ In March, Jefferson Manor in Louisville was cited after 95-year-old Eva Karem was resuscitated in February 2008 despite a DNR order. (It received a citation that was not as serious as a Type A.)

The Karem case prompted a series of meetings of lawmakers, nursing home officials and others who are looking at the use of wristbands.

"It is very important to accurately identify patients' preferences regarding resuscitation, while also protecting their privacy, which is a factor we will be taking into careful consideration when making our decision," she said.

Defendant nursing homes in litigation often attempt to confuse the jury regarding DNR orders.  Nursing homes always claim that a DNR allows them to ignore and neglect residents because "the family signed the order and must have wanted him/her dead".  Ridiculous.

 

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The Lexington Herald-Leader had an article about a Richmond nursing home facing allegations of abuse has been added to a list of nursing facilities requiring federal oversight.   The federal Department of Health and Human Services' Centers for Medicare and Medicaid Services added Richmond Health and Rehabilitation Center to its "Special Focus Facilities" list in April.

The Richmond Register reports the facility also known as Madison Manor is considered "Class A," meaning it is newly added and pending a standard survey by federal inspectors.  The "Special Focus Facilities" list highlights facilities that either have more problems than most nursing homes, more serious problems than most other homes or a pattern of serious problems over a long period of time, according to the department.

The Kentucky attorney general's office is investigating allegations of abuse at the facility after the family of the late Armeda Thomas, 84, hid a video camera in her room in September to document employees' behavior.   That recording led to criminal charges against several former employees of the facility. Former nurse's aide Jaclyn Dawn VanWinkle pleaded guilty last month to reckless abuse or neglect of an adult and received a probated 12-month jail sentence in exchange for assisting prosecutors with their case. She was seen on the video dancing in front of Thomas in her room.

Amanda Sallee of Richmond was charged with wanton abuse and neglect of an adult for allegedly eating Thomas' meals instead of offering them to her or offering to help feed her.

Valerie Lamb of Berea was charged with reckless abuse and neglect of an adult for allegedly lifting Thomas by her neck and lifting her legs higher than necessary when performing incontinent changes, her misdemeanor indictment says.

 

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WBIR.com had a story about a Tennessee nursing home getting caught billing Medicaid for employee bonuses.   Many times Medicaid fraud occurs when nursing homes are being compensated for services they never provided.  It is a waste of taxpayer money and should be strictly enforced as Medicaid fraud.

In the case discussed in the story, the nursing home was over billing TennCare for excessive employee bonuses.  Wayne County Nursing Home and its administrators have agreed to pay $200,000 to settle claims that the home billed the state's expanded Medicaid program too much for bonuses.  It shocks me that nursing homes can use any Medicaid money to pay bonuses for non-licensed health care providers like Administrators.

Attorney General Bob Cooper said state law requires bonuses to be "reasonable", but these bonuses totaled over $1.3 million.   Of course, the state law doesn't define what is reasonable nor do they require that the nursing homes have sufficient staff, deficiency free surveys or any other indicia of good care before allowing these excessive bonuses.  The bonuses were 40 percent of the employees' annual salary in 2004 and were billed to TennCare through the nursing home's cost reports.

 

 

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WCCO out of Minnesota had an article about how most violations in nursing homes are under reported.  This seems like common sense since most employees do not want to risk their jobs admitting mistakes, and there is not enough personnel to enforce the regulations or conduct proper investigations. Many complaints are ignored because the nursing home claims the resident was demented.

The system designed to help Minnesotans choose a nursing home for loved ones is under fire. Serious flaws in the system have been uncovered by a nursing home watchdog group.  You might not know about physical and sexual abuse happening inside the nursing home.

Wes Bledsoe, the founder of a nursing home watchdog group, says he can prove that the rating system on Medicare.gov does not show what is really going on in nursing homes.  For example, after all of the well known abuse at Good Samaritan Society in Albert Lea, a report from the Minnesota Department of Health says no deficiencies were noted at the nursing home.

At a different facility in the state, someone saw an employee pick up a nightgown soaked with urine and that worker "shoved it in the resident's mouth and told her to shut up." Again, the Department of Health didn't note any deficiencies.

A spokesperson from the Minnesota Department of Health said "If a facility has taken appropriate steps to correct problems, they may not be cited with deficiencies."  However, when deficiencies aren't noted, they don't show up on the Medicare site, so there's no way you could know if you've only checked that Web site.

Bledsoe said it's happening all the time. He found that 80 percent of confirmed abuse cases in Minnesota in the last four years didn't get reported to the feds.

"I think it's bureaucratic mumbo-jumbo that's deceiving the consumers and the American public about what's really going on in our long-term care facilities," said Bledsoe.

Bledsoe said another big problem is the star system on the Medicare Web site. On a lot of the nursing home Web sites, a lot of the information is not available, so he's wondering how they can give a place four or five stars when there's no information.

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The Denver Post had a great article on how Colorado has allowed nursing homes to violate state licensing and operational requirements such as manadatory minimum insurance. The Health Care Availability Act requires that nursing homes be insured for $3 million a year, with a cap of $500,000 per incident.   But they also may provide self-insurance if it is approved by the Colorado insurance commissioner.   This lack of insurance leaves vulnerable residents without recourse when they are abused and neglected.  

"These people die, they get abused, and they have no redress," said John Holland. "It's like a state license to kill without financial responsibility."   A lawsuit has been filed to try to get Colorado to follow the law.  The lawsuit seeks a court order requiring the state to make sure the homes are properly insured and to revoke licenses of homes that are not.

The lawsuit was filed on behalf of the families of four people who died in nursing homes and a man who was scalded and lost a testicle as a result of alleged abuse, "grossly substandard care, life-threatening care" and negligence. They are representative members of a class of thousands of residents at 27 nursing homes statewide operated by the SavaSeniorCare chain.

Sava also is being sued for deceptive trade practices for promoting its company as "a leader in state of the art long-term care" and its facilities as the best in the business, while it has one of the worst records in the state with nursing home regulators.

Sava's facilities racked up 1,464 citations for deficiencies from 2006 to 2008 — triple the national average. Twenty of the facilities are rated as below average, according to health department records.  Residents have died of dehydration, malnutrition, and blood poisoning caused by neglected bed sores which called Sava's quality of care "a horror story" compared with most other facilities in Colorado.

The Colorado Department of Public Health and Environment adopted a policy in 2004 that allowed the homes to insure themselves if they submitted an affidavit stating that they have set aside up to $1 million for that purpose.  The problem is that the affidavits are false, there is no money to back up the insurance claim, and the state did nothing to verify that the money was there, the lawyers claim.

 

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The Des Moines Register has an interesting story about Congress considering legislation that would eliminate taxpayer funded bonuses to nursing homes. Nursing homes around the country are getting hundreds of millions of dollars in taxpayer funded bonuses despite history of violations.

The legislation is an amendment to the budget bill that has been debated by Congress. The amendment was accepted by unanimous consent of the Senate on Thursday, but the bill itself has yet to be approved. The Des Moines Register reported last November that nursing homes throughout the country are earning hundreds of millions of dollars in taxpayer-funded bonuses despite violations of basic health-and-safety standards.

Nationally, the total cost of the bonuses is unknown. The Centers for Medicare and Medicaid Services, which approves and helps fund each of the bonus programs, does not track the payments. Currently, there are 81 bonus-payment programs in 36 states.  How and why do not they not track these bonuses?  Why would we give bonuses to profit-driven companies that short change residents on care and essential activities of daily living such as eating, bathing, and hygiene?  What a waste of taxpayer money!

The Register examined eight programs in the seven states where recent regulatory violations don't disqualify a nursing home from receiving a bonus that is touted as being directly related to quality care. Those eight programs cost taxpayers $312 million per year. Some of the largest bonuses to poor-performing homes have been in Oklahoma, the home of Republican Sen. Tom Coburn, a medical doctor. Coburn authored Thursday's amendment, telling his Senate colleagues that taxpayers shouldn't be billed for bonuses paid to inferior care facilities.

"We paid out in excess of $300 million in bonuses to nursing homes that had significant problems in terms of giving the care and meeting Medicare standards," he said. "Why? Why wouldn't we fix that?"

Coburn's amendment would prohibit federally funded bonuses to nursing homes and any other government contractors that "fail to meet basic performance requirements." Coburn has likened the bonuses to those paid to executives at American International Group, or AIG, the insurer that has received $182 billion in federal bailout money.

In Iowa, the Register found that 16 of 23 homes hit with major fines in 2007 qualified for 2008 bonuses. Two homes that earned bonuses were on a federal list of the worst nursing homes in the nation, and a third faced the threat of having its license pulled because of substandard care.

In New Hampshire, the bonus program was dubbed the Medicaid Quality Incentive Payment to ensure legislative approval, although state officials there acknowledge the program includes no incentives or benchmarks for quality care. In other states, homes have been given bonuses to pay for legally mandated requirements, such as the installation of fire sprinklers or the payment of minimum wage.

 

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The Star-Telegram had a story about nursing home employees who stole and embezzled money from the residents at a nursing home.  This is outrageous and it happens quite often.  Taxpayers are the ones who end up paying for these thefts.  The nursing homes should pay more attention to their finances and laws need to be passed that provide for transparency in nursing home financial transactions.

Terry Dean West and Elizandro Valdez Arana pleaded guilty this week to federal felony charges related to their embezzlement of about $42,000 from Medicaid, insurance carriers and a corporation that operated 10 Texas nursing homes including one in Fort Worth.  They pled to making false statements related to health care matters and aiding and abetting in the embezzlement scheme.   There is no reason mentioned why they weren't charged with embezzlement.

West was working as a financial analyst for the Georgia-based Sava Senior Care Corp. in 2006 when he devised a scheme to embezzle money from Medicaid, private insurance carriers and Sava, which operated 10 Texas nursing homes and dozens of others nationwide.

West’s duties including overseeing the business managers of the Pampa Nursing Center in Pampa and the Arlington Heights Health and Rehabilitation Center in Fort Worth. In that capacity, he was required to refund excess payments to Medicaid, insurance carriers or residents of the centers.  West hired Arana to provide his name and that of an alias to use to cash funds containing the embezzled funds.

West admitted altering patient records to show non-existent credit balances and to create false names and addresses of the parties to whom the refunds should be mailed. He then issued refund checks to those newly created parties and mailed them to a post office box the pair had rented. They cashed the checks for their own use.

The scheme involved altering patient records to show non-existent credit balances and to create false names and addresses where refunds were mailed.

 

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The New york Times had an article explaining the Obama administration's plan to overhaul financial regulation by subjecting hedge funds and traders of exotic financial instruments to potentially strict new government supervision. Many of these hedge funds and financial instruments own or have a financial stake in numerous nursing homes around the country.  It states that the government would have the power to peer into the inner workings of companies that currently escape most federal supervision, and specifically cites "private equity firms like the Carlyle Group."   

The Carlyle Group bought out Manor Care a couple of years ago and have created sham L.L.C.s to protect themselves from liability while cutting the budgets of the nursing homes that they own.  In fact, two men who worked in the New York State comptroller’s office were arrested recently after it was discovered they took millions of dollars in kickbacks from private equity and hedge funds.  David Loglisci, who was the top investment officer of the state’s $122 billion pension fund, along with Henry Morris, who fund-raised for former comptroller Alan Hevesi, were nailed in a 123-count indictment, which included charges of money laundering, securities fraud and bribery. It was discovered that over 20 transactions made by the pension fund involved kickbacks, with five of those coming from the renowned private equity fund The Carlyle Group. Morris, who was released after posting a $1 million cash bail, allegedly received $13 million from The Carlyle Group, from investments that totaled $730 million.

The administration would require that all standardized derivatives be traded through a regulated clearinghouse. Traders would be required to provide documentation on their collateral and borrowings. They would also be subject to new eligibility requirements, and their trading and settlement practices would be subject to new standards.

 

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The Hour had an article about Connecticut Governor M. Jodi Rell announcement that her administration has given the Legislature's Public Health Committee testimony in support of her bill to provide greater state oversight over nursing home administration and management including ongoing financial monitoring and expanded quality of care reviews of nursing homes.

An Act Concerning Oversight of Nursing Homes would:

1.  identify areas of the state which either need or have a surplus of nursing home beds;

2. create an oversight committee to focus on financial solvency and quality of care issues;

3.  enhance the public's access to important nursing home data;

4.  provide for greater oversight by the Department of Social Services when there is an application for a change of ownership;

5.  require expanded financial reporting to DSS;

6.   require that nursing homes submit quarterly reports of accounts payable to DSS -- as unpaid bills are a key indicator of financial health; and provide state regulatory agencies with expanded subpoena authority.

"Placing a loved one in a nursing home is often a necessary, but difficult decision and family members deserve the peace of mind of knowing that the finances and the quality of care issues of these facilities are closely monitored," Rell said. "When a nursing home goes out of business due to financial issues, both patients and their families must suffer through the turmoil of a new placement.

"Nursing homes are an important part of the network of care and services for Connecticut residents and quality of care issues are paramount to individuals who have a family member in a nursing facility," the governor said. "We must do everything in our power to ensure a standard of care that instills confidence in the people who are entrusting loved ones to a nursing facility."
 

I wish every State especially South Carolina would pass similar legislation.

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Seattle Post-Intelligencer had an article about the recent SEC complaint filed against Sunwest for fraud.  Sunwest Management Inc. runs one of the largest chains of nursing homes in the country.

The SEC asserts that Sunwest lied to investors about its operations, concealed risks from them and exposed them to massive losses before Sunwest's collapse.  The SEC also asked for an emergency court order freezing the assets of Sunwest.  Sunwest, which manages 250 senior housing projects in 37 states, had defaulted on a number of loans last year after it began to run out of cash and couldn't tap into any more credit.

The government alleges that Sunwest misled investors by telling them the company had never missed a payment and would generate 10 percent returns. "In reality, at least half of the homes managed by Sunwest had been losing money, and investors were taking on huge risk for illusory profits."

McKnight's followed up with an article describing the fraud as a Ponzi scheme.  Sunwest defrauded investors out of roughly $300 million in a Ponzi scheme.  According to the SEC, Sunwest raised $300 million from 1,300 investors between 2006 and 2008. Investors thought they were purchasing partial ownership of one of Sunwest's facilities, and had been guaranteed an annual return of 10%.   Instead, Sunwest placed the money in one fund that it used to pay operating expenses, investor returns and other costs. Investors were never informed that many of the facilities they thought they had invested in were actually losing money.

I wonder how much money the officers and directors stole from the company before the collapse.  These people should share a jail cell with Bernie Madoff.

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The Washington Post had an article about the Bush administration's rule to stop a source of information about abuse and neglect in long-term care facilities that are crucial to finding answers.

The rule designates state inspectors and Medicare and Medicaid contractors as federal employees, a group usually shielded from providing evidence for either side in private litigation.  The new rule, which was issued in September, generally prohibits state health departments and contractors from participating in private lawsuits involving facilities that are in the federal assistance program without approval by the head of the Department of Health and Human Services.

The restrictions affect about 16,000 nursing facilities and 3 million residents in the United States. The practical effect is to force families to go to greater lengths, including seeking court orders, to get inspection reports or depositions for cases they are pursuing.

The change, which affects the $144 billion nursing-home industry, was enacted with no public notice or attention.

"This change hurts nursing-home residents and their families by allowing bad practices to be kept in secret by nursing homes and inspectors," said Eric M. Carlson, an attorney with the National Senior Citizens Law Center in Los Angeles. "Government inspectors have the right to go into nursing homes and investigate, and they learn things that residents and families otherwise could never find out."

The effect of the directives has started to play out in the nation's courtrooms. Requests for information, once fairly routine, now are stalled between state and federal officials.

 

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Pittsburg Tribune Review had an article discussing the failures of Pittsburgh's nursing homes.   The article mentions several examples such as one resident cried out for water before going to the hospital with dehydration; another broke an eye socket when a wheelchair rolled down a ramp and crashed; a patient died when workers improperly adjusted a breathing tube; two were so malnourished that they weighed less than 80 pounds each;  a resident did not get a hair wash for nearly four weeks;  and another was told to "go in your pants" when requesting help with going to the bathroom.   These are common complaints at all nursing homes around the country due to understaffing, burn-out, and lack of training.

Those cases and more were drawn from a Tribune-Review analysis of state surveys conducted at 118 nursing homes in Western Pennsylvania over the past three years.  Inspectors cited homes for 3,798 deficiencies, and in 33 cases, found serious lapses posing "actual harm" or "immediate jeopardy," under federal definition.  Among the deficiencies, inspectors noted hundreds of incidents that caused pain or discomfort for nursing-home residents. Those violations have the "potential for more than minimal harm." They include failures to treat skin ulcers or to help patients eat when they can't feed themselves.  Most often, problems related to quality of care or unsanitary conditions.

Rosalie Kane, a professor of public health at the University of Minnesota, said that the quality of life for nursing-home residents has not improved — even if surveys don't find as many alarming violations.  "Those surveys don't make nursing homes better over time," Kane said. "They just represent the lowest common denominator keyed to issues that are considered unacceptable."

The Trib's review followed the November arrests of five employees at Kane Regional Center in Glen Hazel, who were charged with abusing and tormenting a 94-year-old Alzheimer's patient. More than 2,800 complaints of abuse or neglect of nursing home patients are substantiated each year, according to the inspector general for the Department of Health and Human Services.

Nursing homes do not spend enough money on staffing required to ensure adequate care.  Nursing home staff members decide whether residents' preferences are met. Too much of nursing home operations revolve around what's convenient for staff, not patients.

Nursing home staff and inspectors should ask residents whether they participate in meaningful activities, whether they have opportunity to have private conversations, and what they like or don't like about the food.

Under federal law, state health inspectors must survey nursing homes at least once every 15 months and whenever they receive a complaint. Often, homes are cited for a serious deficiency only after a patient is seriously harmed.

 

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Worcester Telegram & Gazette News had a great article discussing the deficiencies in nursing homes in Massachusetts although this article could have been written about any state.  

The article states that local nursing homes have been reprimanded in recent years for physical and sexual abuse, neglect and other serious mistreatment of elderly residents, according to state reports.   The deficiencies range from minor to serious including cold food to filthy bathrooms to violations of patient rights, medication errors and preventable falls in at least three patient deaths over the last three years.

A Telegram & Gazette review and analysis of hundreds of pages of state and federal inspection reports on the region’s nursing homes as well as summaries of state investigations prompted by patient and family complaints found:

• The state Department of Public Health rated 14 area nursing homes — more than 20 percent of the region’s 62 facilities — among the worst in the state as of November. Three of those were rated in the bottom 4 percent statewide, and four others in the bottom 6 percent.

• Federal regulators have fined 21 area nursing homes a total of more than $150,000 for serious and repeated violations of Medicaid regulations since 2005.

• The quality of local nursing homes varies widely from several that scored perfect or nearly so in state inspections to a handful of problem facilities whose scores are among the lowest in the region and that have been investigated repeatedly. The latter often were cited for poor care, in response to complaints from patients and their families.

• Among those complaints, state inspectors validated at least five local cases of physical abuse and 10 cases of neglect over the last three years.

Among the scores of complaints lodged against area nursing homes and substantiated by state investigators were a number of claims of physical abuse.

Radius Healthcare of Southbridge, a for-profit nursing home licensed for 144 beds, was cited for physical abuse of residents in February 2006 and again in December 2006, according to investigation summaries. Third and fourth complaints of physical abuse in April and October were also investigated.

During an annual inspection in February 2008, the state surveyor reported residents whose wheelchairs would not fit under dining room tables, forcing the elderly patients to hold drinks and food in shaking hands for long periods. One resident of the nursing home also went more than eight months without seeing the facility doctor, according to the inspection report.

Medicaid reimburses nursing homes an average of $180 a day per patient in Massachusetts.  The state nursing home trade association puts the average retail price of care for those paying out of pocket at $270 a day, or more than $98,000 a year.

An advocacy group pushing for higher-quality nursing home care in the state, Massachusetts Advocates for Nursing Home Reform, maintains that a complete overhaul of the system is needed. The group is calling on the industry to move away from what it calls a “hospital-like model.”

 

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Stephanie Flemmons at sflemmons@acnpapers.com had a great article in the Plano Courier.  The article discusses how a complaint was handled by the state agency responsible for investigating nursing home resident's complaints.  Richard Ward was a resident who received a serious medication error that could have killed him.  The Texas Department of Aging and Disability Services ruled not to take any action against a facility that almost killed him.

“It strikes me as, you may have made a medication error that could have killed someone, but oh well,” Ward said. “We are not working on cars here, we are working on people.”

Ward’s formal complaint stated that the Life Care Center of Plano failed to administer the proper medication, which almost caused a fatal heart attack.  When Ward admitted himself to Life Care, he provided the nursing staff with an itemized list of the types of medications he was required to take, what the dosages were and the actual medications.

Ward said the nursing staff failed to administer his Coumadin.  He became aware days later when his physician conducted her examination.  “When the doctor conducted her physical it was almost too late,” Ward said. “She panicked after the results from an INR test came back normal. A normal level for a person with my heart conditions is a dangerous place.”

The physician immediately ordered Lovenox injections and Coumadin.  “I felt like I was on the brink of death,” Ward said. “I panicked.”

That night on May 28, Ward received his required Coumadin.  The next day the errors kept occurring. He received his Lovenox the next morning, but did not receive it that night.

“Medication time is at 9 p.m. and I waited until 10:30 p.m. to ask the nurses,” Ward said. “They argued with me. I had to force them to look it up.”   Ward said they realized they made a mistake, but at that point he had had enough.  “I thought these people were going to kill me,” Ward said. “That was their last chance.”

The state agency ruled this claim as unsubstantiated or unverified.

“I am flabbergasted,” Ward said. “I brought them a typed list of every medication that I picked up from the Medical Center of Plano before I admitted myself.”   Ward discharged himself from Life Care.  He reviewed his medical records.  The typed list was no longer in the records.

“They took it out because it showed blatant negligence,” Ward said. “All they had to do was lose one piece of paper and they wouldn’t look so bad.”

Ward’s second complaint alleged that the facility failed to maintain accurate clinical records.  DADS did find that the facility did have his name incorrect, but they did not issue a citation.

“How would they know who they were giving medicine to if they did not have the patient’s correct name?” Ward said. “At some point they gave me medicine, without the correct name on my records.”

Ward wrote prescriptions for 20 years in the Army and as a civilian.  He is concerned that the state agency’s rulings on both claims proves future such rulings could take the life of an innocent person.  “You just can’t make a mistake like this and not have any repercussions,” Ward said. “If they are doing this to someone who is awake and alert and knows how to read medical records, I’m sure they are doing this to someone else. I’m not an isolated case.”

Ward said they never contacted any of his family members or even asked him many questions regarding the claim.   According to DADS annual report, medication errors are No. 8 in their top 10 list for complaints.

 

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MSNBC had a story about the citation and fine received by a nursing home for failing to supervise a resident while smoking causing wrongful death.  The state Department of Public Health announced an "AA" citation -- the most severe penalty under state law -- against
the Lemon Grove Care and Rehabilitation Center, based on inadequate care causing a patient's death.

The citation stems from an incident in March, 2008, when a 76-year-old resident was left unattended by the staff in a designated smoking area and caught fire. By the time the staff became aware of the situation, the man was engulfed in flames.  It is unclear how long the man was left unattended or why the staff was not attentive while residents were in the designated smoking area.

Dr. Mark Horton, director of the Department of Public Health, said the Lemon Grove center failed to protect the health and safety of its residents by not providing adequate resident supervision, resulting in the patient suffering fatal injuries.  The CDPH said its citation process -- which ranges from "B" to "AA," is part of its ongoing enforcement efforts to improve the quality of care provided to residents of the state's 1,400 skilled nursing facilities.

The Lemon Grove facility was also fined $80,000.

 

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Last night’s MSNBC Countdown with Keith Olbermann reported on a nursing home rule consumer advocates have been working tirelessly to highlight in the media and correct.   Before leaving office, President Bush silently pushed through this rule protecting the $144 billion nursing home industry. Occurring without any public notice or comment, the rule prevents families from receiving critical information about loved ones abused or neglected when suing nursing home corporations.

 

In addition to the Countdown segment, Bloomberg and Mother Jones have more on this rule that protects negligent nursing homes while leaving patients without details of government investigations into abuse and neglect.

 

The rule designates state inspectors and Medicare and Medicaid contractors as federal employees, a group usually shielded from providing evidence for either side in private litigation.  The restrictions affect about 16,000 nursing facilities in the U.S. and 3 million residents. The practical effect is to force litigants to go to greater lengths, including seeking court orders, to get inspection reports or depositions for cases they are pursuing or defending.

What is the point of an investigation or regulatory enforcement if the information is not made public?

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We have many people call us asking for advice on how to choose a nursing home. Many of the people seeking advice want to rely on Medicare's star ratings.  We are not convinced that these star ratings give an accurate assessment of a nursing home's ability to provide good care.  The ratings are primarily based on surveys and investigations done by the Department of Health and Environmental Control (DHEC).  Well, the problem with that is DHEC tells the facilities when they are going to investigate or conduct a survey giving the facilities time to get their best nurses in the facility, to staff more than typical, and make sure all the documentation is revisited and changed if lacking.  

When abuse or neglect is reported, the state's investigations procedurally favor the facilities. Violations must be actually found in the facilities' own documentation, which are very self-serving. We cannot rely on the state for enforcement of regulations that are designed to protect residents and ensure proper care.

The key to quality of care is competent, compassionate, and well-trained staff.  They are less likely to get burnt-out and more likely to stay in the job thus lowering turnover rates which are detrimental to residents especially those with dementia.  The reality often is that staff who complain about resident neglect don't remain employed.  Fortunately there are laws to protect workers from retaliatory firing, but many employees still fear losing their jobs by speaking up.  Regulations exist to protect residents from neglect, but residents and employees fear retaliation. Many times families aren't aware neglect is occurring. Facilities lie and cover up to protect themselves from liability.

There are no "good" facilities here.  Unfortunately the best that one can hope for is "average" — with most "below average."  It is tragic that our area does not have "above average" facilities available. We should be outraged. Our tax payer money is going to these facilities. instead of providing quality care and adequate staffing, the facilities send the money to "management" companies that are owned by the same people who own the nursing home and don't actually provide any services.

Our community needs to make it less profitable for nursing homes to neglect our elderly. A society is ultimately judged by how it treats its most vulnerable members. At this time civil actions are the only effective solution. The state won't do it.
 

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The Dallas News had an article about the role that Ombudsman's office has in advocating for nursing home residents.  The article stresses the importance of their role and the breadth of their power and responsibility. However, it all depends on the State's funding and the specific Ombudsman's knowledge of the regulations and standard of care.

The article revolves around Jennelle Dixson who is a nursing home ombudsman who looks out for residents too frail or too afraid to speak up about problems such as inattentive caregivers, dirty bedding and long delays in getting medication.   Ombudsmen are among the most important watchdogs of the nursing home industry.  The frequent prods and nudges they give nursing home administrators can have almost as much influence on the quality of care as the annual inspections that government regulators make.

The Senior Source, the nonprofit agency that runs the state's long-term ombudsman program in Dallas County, sends ombudsmen to 63 nursing homes at least once a month and 160 assisted-living communities at least twice a year.  Dixson checks on more than 1,000 residents in 17 nursing homes throughout Dallas. She visits most of the homes weekly. 

Forty-three percent of Americans who reach 65 can expect to spend time in one of the nation's 15,281 nursing homes. The average stay is almost 2 ½ years.

Though ombudsmen often meet an uncooperative administrator, their visits sometimes produce results because most nursing homes prefer to resolve issues before they escalate into black marks during state inspections. Last year, the Senior Source's ombudsmen received 8,600 complaints about nursing homes and 600 complaints about assisted-living communities in Dallas County.

Swanson says complaints involving abuse or serious neglect go to the Texas Department of Aging and Disability Services, the state agency that inspects and regulates nursing homes and assisted-living communities. "The most common complaint we receive is that caregivers take too long to answer residents' call buttons," Swanson said. "Patients may wait an hour for aides to escort them to the bathroom."   This lack of response often results in falls when residents attempt to make it to the bathroom without assistance.

I don't doubt that Mrs. Dixson is a caring ombudsman who benefits residents under her jurisdiction but the Ombudsman in South Carolina do absolutely nothing for the residents.  They do not act like advocates and often defend the actions or inactions of the nursing homes all the time stating "that is what my boss tells me to do."  The ombudsmen in South Carolina do not feel they have any power or right to tell the nursing homes how to provide care to the residents. If that is true, what is the point of their existence?  South Carolina needs to train the ombudsmen and give them the power and authority to challenge the nursing homes to prevent neglect and abuse.

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 There is an article about The Justice Department's settlement with the state of Tennessee regarding civil rights violations at the Tennessee State Veterans Homes (TSVHs) in Humboldt and Murfreesboro. The TSVHs are state-owned nursing homes, each serving approximately 140 residents, most of whom are veterans. It sounds eerily similar to the Bush Administration's last minute settlement with South Carolina recently.

The agreement, filed in U.S. District Court, is designed to (hopefully) ensure that the nursing home residents will (finally) be provided adequate medical and nursing care and protected from harm. During its investigation of the TSVHs, the Justice Department discovered numerous violations, including medical and nursing care that violated generally accepted professional standards, and psychiatric medication practices so deficient that they contributed to the deaths of some residents. Further, staff at the veterans homes did not adequately protect residents from injuries associated with falling.

The Justice Department conducted its investigation pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), which authorizes the Attorney General to investigate and root out systemic deficiencies in care such as those found at the TSVHs, rather than focus on individual civil rights violations.  The Department of Justice's CRIPA enforcement effort reaches beyond nursing homes, and includes psychiatric hospitals, facilities for persons with developmental disabilities, juvenile justice facilities, prisons and jails.

 

 

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The Associated Press had an article about the settlement between the lame duck Bush Administration Department of Justice and C.M. Tucker, Jr. Nursing Care Center run by the State of South Carolina.  There is also one in the Free Times.  If you recall, the Free Times ran the article titled Death at C. M. Tucker almost a year ago and has followed the investigation from the start.  Here are some of the facts of the settlement.

A South Carolina agency and the federal government have reached a settlement eight months after the Justice Department accused a state-run nursing home of providing inadequate care to residents.  Many of  which led to injuries and death.  The settlement was a compromise, and an ugly deal made between Bush outgoing DOJ and SC. The settlement avoids litigation (and avoids further scrutiny and embarassment).   The settlement requires the nursing home to start programs for  training, monitoring, reporting, and evaluation requirements. It requires staff to pay close attention to patients’ weight, food intake, pressure sores and pain management, and all deaths must be reported to the federal agency.  (All of these things should have been done before).

The agreement follows a scathing, detailed report issued by the Justice Department.  This facility is home to 360 residents, including 70 veterans, in three buildings. Many of have severe physical or mental impairment.  The investigation was conducted in fall 2006 under the Civil Rights of Institutionalized Persons Act. Most Tucker residents' care was paid by Medicaid. The May report called the facility a “nursing home of last resort for hundreds of patients with long-term psychiatric illnesses.”

Among the findings, it accused caregivers of not identifying or addressing patients’ swallowing disorders. In one example, it said a 59-year-old man died four weeks after being diagnosed with a lung infection caused by inhaling food or liquid. The report said swallowing problems may have contributed, as the man lost 20 percent of his body weight over four months because he was unable to chew and ingest safely.  Other issues include not regularly turning and repositioning patients to avoid bed sores, not giving dying patients enough pain medication, improper nutrition, not doing enough to prevent falls that cause injury, inadequately investigating accusations of abuse, and unsanitary conditions.

 

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The American Association of Homes and Services for the Aging (AAHSA) developed a Task Force on Survey, Certification and Enforcement.  In June 2008, they issued a report titled Broken and Beyond Repair: Recommendations to Reform The Survey and Certification System.

The AAHSA Task Force on Survey, Certification and Enforcement believes strongly that
despite some measurable, specific successes, the nursing home oversight system has,
overall, failed to fulfill its 20-year-old goals to ensure a nursing facility’s “sustained
compliance” with regulations and to enhance quality of care and quality of life for
residents living in those facilities. The Task Force’s year-long examination has convinced
each of its members not only that the system is not working today – but also that the
system will not work in the future, when a growing number of older Americans with
increasingly complex care needs will seek care in nursing homes. Now is the time – not
tomorrow or next year or five years from now – to take bold steps to design a new system
for ensuring quality of care and quality of life in this country’s nursing homes.

The National Commission for Quality Long-Term Care, a bipartisan study group,
suggested in its December 2007, report that the long-term care system can no longer
depend on “the old ways of doing things.”19 In this report, the Task Force on Survey,
Certification and Enforcement urges AAHSA to take the lead in advocating for steps that
will introduce “new ways of doing things” into the survey and certification system. We
urge the association to consider our recommendations carefully and to act on them
boldly.

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McKnight's had a great article on Senator Kohl's new bill, "Retooling the Health Care Workforce for an Aging America Act of 2008."   The bill has garnered strong praise from the nation's top nursing home advocates.

"The ability to recruit, retain and support high quality talent is essential for providing high-quality care and services," said Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, in a statement. This act will offer more opportunity to invest in the long-term care workforce and effectively meet the needs of an aging society, he added.

The nursing home industry claims that 110,000 full-time healthcare positions in the country are vacant.

Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care, added.

"We are pleased Senator Kohl has introduced this sweeping piece of legislation which deals directly with the fact that demand for long-term care workers far outstrips the available supply of the key workers our profession requires to sustain the provision of quality care today and the years ahead," he said in an announcement.
 

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 The Syracuse Post Standard had an article recently discussing the (small) fine that a nursing home received for neglecting a resident who died as a result of choking.  How could they levy such a small fine for a preventable death? 

The government fined a Minoa nursing home $13,300 for failing to provide prompt emergency care to a choking resident who died.  The Centers for Medicare & Medicaid Services said The Crossings put residents in immediate jeopardy and provided substandard quality of care, the most serious deficiencies.

The Crossings was one of four nursing homes in the region fined for poor care between June 1 and Sept. 19, according to the Long Term Care Community Coalition.   The fine against The Crossings stems from an Oct. 15, 2007, incident involving a resident:  The report said:

The woman was served a dinner of blueberry pancakes and sausage that a nurse aide cut into bite-sized pieces. A short time later, the aide noticed the women's mouth was open, she was not breathing and her lips were blue.  The aide failed to call a "code blue," an announcement that alerts all staff to an emergency situation and summons them to provide assistance. It also activates the 911 system. The aide also failed to start the Heimlich maneuver.  A licensed practical nurse who came to help did not take these steps, either.  The registered nurse supervisor who arrived on the scene did not immediately call a "code blue" or 911.

I wonder what "a short time later" means?  I am surprised the nursing home did not claim that the resident had a DNR so they did not need to intervene!!

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The SCDHEC website has an interesting question and answer session where they discuss nursing homes.  SCDHEC is responsible for licensing and enforcing the standards at nursing homes.  They are woefully understaffed and underfunded.  Below is an excerpt from "conversations with the Commissioner.

How many licensing people in DHEC's whole health licensing side? How many are assigned only to Community Residential Care Facilities?

DHEC’s Division of Health Licensing has 45 positions; three are vacant. The division has 29 inspectors. The community care oversight program has 13 positions. An additional inspector position is proposed, but has not been hired. One administrative person from the division’s operation support program is assigned responsibilities of processing CRCF applications for licensure.

How many investigators in DHEC's whole health licensing side? How many are assigned only to CRCFs?

We have 30 investigator positions. Of these, 11 are specifically assigned to CRCF in the Community Care Oversight Program.

Does DHEC need more inspectors and investigators for the CRCF program? How many?

Currently, the DHEC’s Division of Health Licensing licenses 489 CRCF’s with a total of 16,637 beds. We are assessing the CRCF program to determine how best to achieve the goals and responsibilities of the program. We’ll be happy to share the results once the study is completed.

Does this program have annual reports? (DHEC's solid waste division, for example, produces annually a nice comprehensive report.)

No.

How many natural deaths occur each year in CRCFs?

We do not collect that information as it is not required to be reported to DHEC by the facilities. We are to be notified by the facility of a death where there is an unusual circumstance that involves an investigation by the coroner or local law enforcement. We would investigate to determine whether there would be any violations of DHEC regulations that occurred. The investigation into the cause of the death and any criminal charges brought in the matter would be left to the coroner and local law enforcement agencies under their authority.

How many deaths due to staff negligence or inadequate staffing occur each year in CRCFs? (This question includes residents like the wheelchair death of a Peachtree Manor man, who was a resident but he was being pushed down the road.)

We are to be notified by the facilities when there is a death that is investigated by the coroner or local law enforcement. Criminal charges that may be brought would be done by those local authorities.

How many injuries occur each year in CRCFs? What is the nature of the injuries?

The facilities are required to notify DHEC of serious injuries that require hospitalization due to incidents involving fractures, burns, lacerations, hematomas, etc. While that information is reported to DHEC, we do not have the specific numbers compiled.

How many complaints do you get each year about CRCFs? How many are justified? What are the categories of complaints?

For the fiscal year July 1, 2007 to June 30, 2008, we received 569 CRCF complaints alleging 2,592 various issues which resulted in 579 citations.

For the current fiscal year from July 1, 2008, we have received 186 complaints alleging 886 issues for which 14 citations have been cited. Some findings for this period are inconclusive at this time as most of the complaints are still open.

Often the citations noted were not associated with the original complaint. Many times we are unable to determine if the complaint was justified.

The complaints are typically taken under the following headings:

Abuse
Accessibility
Activities
Administrative
Animals
Background Checks
Care Plans
Charting/Records
Dietary/Food
Dirty Needles
Dumping
Finances
Fire Code
Housekeeping
Incident Reports
Level of Care
Maintenance
Misappropriations
Oxygen
Patient Rights
Pharmacology
Quality Program
Recreation Staff Unlicensed
Safety
Staff
Staff Training
TB Requirements
How many CRCFs has DHEC closed in recent years?

Within the most recent years DHEC has actively been involved in the forced closure of one facility; Peachtree Manor.

All other closures have been as a result of the voluntary surrender of the facility’s license or closure of the facility as a decision made by the licensee/owner. Our enforcement actions have contributed to many of the voluntary closures.

About how many CRCFs are like Still Hopes (a CRFC in West Columbia) where mostly upper income folks go.

We do not compile information whether a facility is strictly private or whether it accepts residents that receive the Optional State Supplement (OSS) or both. You can contact the S.C. Department of Health & Human Services to request information on those facilities residents who receive the OSS supplement.

The CRCF at Still Hopes is only one part of that overall facility. Still Hopes has apartments for independent living as well as a skilled-care nursing home.

Describe briefly DHEC's main concerns with its CRCF program.

Compliance with the requirements of Regulation 61-84, Standards for Licensing Community Residential Care Facilities. Pam Dukes and Commissioner Hunter can elaborate on this question at your meeting this afternoon.

Describe briefly how DHEC wants to address those concerns.

The Division of Health Licensing is reviewing Regulation 61-84 for possible revision. We are studying possible changes in the programs. We expect to have that process completed within the next 30 days.

Can I attend the 1 p.m. Oct. 22 CRCF meeting at the Heritage Building in Columbia mentioned in Ken Moore’s Sept. 26 memo?

This meeting is for our staff and invited directly affected stakeholders to review the CRCF program and potential regulatory changes. As such, the session is not considered a “public” meeting based on input from the agency’s legal staff as the group does not constitute a public body. Allowing media participation may significantly limit our ability to engage stakeholders in a completely open and frank dialogue. We do encourage you to attend future public CRCF meetings that will be held as we continue this process.

(Question 1 response) You write, “The Community Care Oversight Program has 13 positions.” Q. My questions: How many of these positions are filled with full-time on-duty people?

All 13 are full-time on-duty staff.

How many of these positions with full-time on-duty people are devoted EXCLUSIVELY to CRCFs? (The 489 facilities you regulate).

None of the 13 are devoted exclusively to CRCF.

Of the positions EXCLUSIVELY devoted by CRCFs and filled now by full-time on-duty FTEs, how many are investigators? Inspectors? (This entire question may be most easily addressed on the phone with someone. I just want to be sure we are describing your staffpower accurately. For example, we have a lot more positions in our newsroom than actual workers. We have lost many through buyouts, attrition, etc. Saying you have a position doesn't reveal much about actual staffing.)

The CRCF program staff that inspect facilities are inspectors. The program does not use the position title of investigator.

(Questions 2 response) Does the “Community Care Oversight Program” only concern the 489 CRCFs, or does it include other types of facilities?

The Community Care Oversight program includes 87 Intermediate Care Facilities for the Mentally Retarded (MR15 and MR16). There are a total of 1,864 ICFMR beds.

(Question 8 response) You say for FY 07-08 you received 569 CRCF complaints alleging 2,592 issues... etc. (my question: Does this include the complaints forwarded to you by the Ombudsman’s office and Gloria Prevost’s group, Protection and Advocacy, which does about 85 contract inspections of CRCF’s a year for Department of Mental Health and forwards complaints to DHEC?)

Yes, but not all information forwarded to the CRCF program from these groups requires a DHEC investigation. Often, either the findings provided from their complaint investigation or the complaint itself is not within our scope of authority.

(Question 9 response)... Any idea how many closures in the past 3-4 years have been attributable in part to DHEC enforcement actions besides Peachtree?

Approximately 16 since 2004

On a different but related note: How many patients in state nursing homes? How many nursing homes?

For clarification, are you asking how many nursing homes are owned by the State of South Carolina, and how many patients are served in those homes? Or, is your question more general?

The general answer is that in South Carolina, we license 195 nursing homes with 19,647 beds. Most nursing homes in the state operate at over 95 percent occupancy.

If you want to know how many are State of South Carolina owned and how many beds are in those homes, we will need a couple of days to get you that information.

 

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The SCDHEC website has an interesting question and answer session where they discuss nursing homes.  SCDHEC is responsible for licensing and enforcing the standards at nursing homes.  They are woefully understaffed and underfunded.  Below is an excerpt from "conversations with the Commissioner.

How many licensing people in DHEC's whole health licensing side? How many are assigned only to Community Residential Care Facilities?

DHEC’s Division of Health Licensing has 45 positions; three are vacant. The division has 29 inspectors. The community care oversight program has 13 positions. An additional inspector position is proposed, but has not been hired. One administrative person from the division’s operation support program is assigned responsibilities of processing CRCF applications for licensure.

How many investigators in DHEC's whole health licensing side? How many are assigned only to CRCFs?

We have 30 investigator positions. Of these, 11 are specifically assigned to CRCF in the Community Care Oversight Program.

Does DHEC need more inspectors and investigators for the CRCF program? How many?

Currently, the DHEC’s Division of Health Licensing licenses 489 CRCF’s with a total of 16,637 beds. We are assessing the CRCF program to determine how best to achieve the goals and responsibilities of the program. We’ll be happy to share the results once the study is completed.

Does this program have annual reports? (DHEC's solid waste division, for example, produces annually a nice comprehensive report.)

No.

How many natural deaths occur each year in CRCFs?

We do not collect that information as it is not required to be reported to DHEC by the facilities. We are to be notified by the facility of a death where there is an unusual circumstance that involves an investigation by the coroner or local law enforcement. We would investigate to determine whether there would be any violations of DHEC regulations that occurred. The investigation into the cause of the death and any criminal charges brought in the matter would be left to the coroner and local law enforcement agencies under their authority.

How many deaths due to staff negligence or inadequate staffing occur each year in CRCFs? (This question includes residents like the wheelchair death of a Peachtree Manor man, who was a resident but he was being pushed down the road.)

We are to be notified by the facilities when there is a death that is investigated by the coroner or local law enforcement. Criminal charges that may be brought would be done by those local authorities.

How many injuries occur each year in CRCFs? What is the nature of the injuries?

The facilities are required to notify DHEC of serious injuries that require hospitalization due to incidents involving fractures, burns, lacerations, hematomas, etc. While that information is reported to DHEC, we do not have the specific numbers compiled.

How many complaints do you get each year about CRCFs? How many are justified? What are the categories of complaints?

For the fiscal year July 1, 2007 to June 30, 2008, we received 569 CRCF complaints alleging 2,592 various issues which resulted in 579 citations.

For the current fiscal year from July 1, 2008, we have received 186 complaints alleging 886 issues for which 14 citations have been cited. Some findings for this period are inconclusive at this time as most of the complaints are still open.

Often the citations noted were not associated with the original complaint. Many times we are unable to determine if the complaint was justified.

The complaints are typically taken under the following headings:

Abuse
Accessibility
Activities
Administrative
Animals
Background Checks
Care Plans
Charting/Records
Dietary/Food
Dirty Needles
Dumping
Finances
Fire Code
Housekeeping
Incident Reports
Level of Care
Maintenance
Misappropriations
Oxygen
Patient Rights
Pharmacology
Quality Program
Recreation Staff Unlicensed
Safety
Staff
Staff Training
TB Requirements
How many CRCFs has DHEC closed in recent years?

Within the most recent years DHEC has actively been involved in the forced closure of one facility; Peachtree Manor.

All other closures have been as a result of the voluntary surrender of the facility’s license or closure of the facility as a decision made by the licensee/owner. Our enforcement actions have contributed to many of the voluntary closures.

About how many CRCFs are like Still Hopes (a CRFC in West Columbia) where mostly upper income folks go.

We do not compile information whether a facility is strictly private or whether it accepts residents that receive the Optional State Supplement (OSS) or both. You can contact the S.C. Department of Health & Human Services to request information on those facilities residents who receive the OSS supplement.

The CRCF at Still Hopes is only one part of that overall facility. Still Hopes has apartments for independent living as well as a skilled-care nursing home.

Describe briefly DHEC's main concerns with its CRCF program.

Compliance with the requirements of Regulation 61-84, Standards for Licensing Community Residential Care Facilities. Pam Dukes and Commissioner Hunter can elaborate on this question at your meeting this afternoon.

Describe briefly how DHEC wants to address those concerns.

The Division of Health Licensing is reviewing Regulation 61-84 for possible revision. We are studying possible changes in the programs. We expect to have that process completed within the next 30 days.

Can I attend the 1 p.m. Oct. 22 CRCF meeting at the Heritage Building in Columbia mentioned in Ken Moore’s Sept. 26 memo?

This meeting is for our staff and invited directly affected stakeholders to review the CRCF program and potential regulatory changes. As such, the session is not considered a “public” meeting based on input from the agency’s legal staff as the group does not constitute a public body. Allowing media participation may significantly limit our ability to engage stakeholders in a completely open and frank dialogue. We do encourage you to attend future public CRCF meetings that will be held as we continue this process.

(Question 1 response) You write, “The Community Care Oversight Program has 13 positions.” Q. My questions: How many of these positions are filled with full-time on-duty people?

All 13 are full-time on-duty staff.

How many of these positions with full-time on-duty people are devoted EXCLUSIVELY to CRCFs? (The 489 facilities you regulate).

None of the 13 are devoted exclusively to CRCF.

Of the positions EXCLUSIVELY devoted by CRCFs and filled now by full-time on-duty FTEs, how many are investigators? Inspectors? (This entire question may be most easily addressed on the phone with someone. I just want to be sure we are describing your staffpower accurately. For example, we have a lot more positions in our newsroom than actual workers. We have lost many through buyouts, attrition, etc. Saying you have a position doesn't reveal much about actual staffing.)

The CRCF program staff that inspect facilities are inspectors. The program does not use the position title of investigator.

(Questions 2 response) Does the “Community Care Oversight Program” only concern the 489 CRCFs, or does it include other types of facilities?

The Community Care Oversight program includes 87 Intermediate Care Facilities for the Mentally Retarded (MR15 and MR16). There are a total of 1,864 ICFMR beds.

(Question 8 response) You say for FY 07-08 you received 569 CRCF complaints alleging 2,592 issues... etc. (my question: Does this include the complaints forwarded to you by the Ombudsman’s office and Gloria Prevost’s group, Protection and Advocacy, which does about 85 contract inspections of CRCF’s a year for Department of Mental Health and forwards complaints to DHEC?)

Yes, but not all information forwarded to the CRCF program from these groups requires a DHEC investigation. Often, either the findings provided from their complaint investigation or the complaint itself is not within our scope of authority.

(Question 9 response)... Any idea how many closures in the past 3-4 years have been attributable in part to DHEC enforcement actions besides Peachtree?

Approximately 16 since 2004

On a different but related note: How many patients in state nursing homes? How many nursing homes?

For clarification, are you asking how many nursing homes are owned by the State of South Carolina, and how many patients are served in those homes? Or, is your question more general?

The general answer is that in South Carolina, we license 195 nursing homes with 19,647 beds. Most nursing homes in the state operate at over 95 percent occupancy.

If you want to know how many are State of South Carolina owned and how many beds are in those homes, we will need a couple of days to get you that information.

 

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Numerous media outlets have discussed the recent report from the Inspector General that shows that 92% of all nursing homes violate the standards established by the federal and state governments.  ABC News had a good article here.

A government report released found extensive problems in America's nursing homes. Nearly one in five of the nearly 15,000 nursing homes examined were cited for violations that put patients in immediate harm in 2007.   92 percent were cited for some type of deficiencies during each of the last three years.

The quality of care in nursing homes was the focus of those deficiencies. Experts also found that  far too many residents waited too long to get the help they needed.

"Very few of these deficiencies ever result in a financial penalty," said Wes Bledsoe, founder of A Perfect Cause, a non-profit group that advocates for the reform in long-term care. "And if they do, they are not collected. The system has no teeth."

"It's a priority for me in this office because sometimes it's a double crime," New York State Attorney General Andrew Cuomo said. "First of all, it's a fraud against the taxpayer. In many cases, taxpayers are actually funding these organizations and these institutions and they're being defrauded. And secondly you are literally affecting the most vulnerable in our society. And that's our first priority -- to protect those people who literally can't protect themselves."

This week's report revealed that for profit homes are actually more likely to have problems than facilities run by local governments or non-profits despite having more resources and making substantial profits.
 

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The NY Times had a recent article about the prevalence of violations in the vast majority of nursing homes. National for profit chains seem to get more violations than others.  The article cited that more than 90 percent of nursing homes were cited for violations of federal health and safety standards last year.   About 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.

Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.  Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.

About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.  The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.

“For-profit nursing homes had a higher average number of deficiencies than the other types of nursing homes,” Mr. Levinson said. “In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.”

On Monday, Mr. Levinson issued a compliance guide for nursing homes that says some homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.” Researchers have found that people receive better care at homes with a higher ratio of nursing staff members to patients.

The inspector general said he had found some cases in which nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all.”

More than 1.5 million people live in the nation’s 15,000 nursing homes. The homes are only inspected once a year and must meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.

Medicare pays a fixed daily amount for each nursing home resident, with higher payments for patients who are more severely ill. Mr. Levinson said some nursing homes had improperly classified patients or overstated the severity of their illnesses so the homes could claim larger Medicare payments.

 

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An independent, broad-based national expert panel should be convened to re-examine the oversight process for nursing homes, a task force from the American Association of Homes and Services for the Aging (AAHSA) concluded in its final report, "Broken and Beyond Repair: Recommendations to Reform the Survey and Certification System."

The report's 31 recommendations include improved communication to surveyors and providers about new requirements and changes to the survey process, standardized job descriptions for surveyors, more efficient use of survey resources, and flexibility to adapt to culture change. The task force's overarching recommendation is that an independent commission, such as the Institute of Medicine, reexamine the survey and certification process to "create a common vision for how our nation should care for its frailest citizens and to recommend a new oversight model for ensuring that this vision becomes reality in every nursing home today."

Bonnie Gauthier acknowledged that "our short-term suggestions alone won't bring the system back to the intent of OBRA 87 -- achieving optimal, quality-based, resident-centered care -- but they will tide the system over until broad systemic change can occur." Immediate changes needed, according to the report, include better public reporting of survey results, joint education of providers and surveyors, and greater overall consistency in the process."

To inform its conclusions, the report includes a digest of interviews with survey agency representatives from seven states and a catalog of surveyor job descriptions from numerous states.
Larry Minnix, AAHSA's president and CEO, said  "This system is angry, broken and can't be fixed. A system based on consistency, fairness and accuracy will help us move toward the day when there are two types of nursing homes: the excellent and the non-existent."

Get copies of the report . 

About AAHSA
The members of the American Association of Homes and Services for the Aging ( www.aahsa.org) help millions of individuals and their families every day through mission-driven, not-for-profit organizations dedicated to providing the services that people need, when they need them, in the place they call home. Our 5,800 member organizations, many of which have served their communities for generations, offer the continuum of aging services: adult day services, home health, community services, senior housing, assisted living residences, continuing care retirement communities and nursing homes. AAHSA's commitment is to create the future of aging services through quality people can trust.
SOURCE American Association of Homes and Services for the Aging
 

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The Milwuakee Journal had an excellent 2 part series on nursing homes recently.  They can be found here and here.

The Journal describes how dozens of nursing homes in Wisconsin have been cited for improper care after the deaths of 56 residents since 2005 - a period marked by a dramatic surge in serious violations around the state.  Neglect was noted after hundreds of elderly or disabled nursing home residents were found with bruises, broken bones or pressure ulcers - some so deep they tunneled to the bone.   In hundreds of cases, reports document how inadequate training, lack of supervision and understaffing contributed to a rising number of injuries.

The Journal Sentinel built a database from thousands of pages of nursing home regulatory records over the past 3 1/2 years. Among the findings:

• Health care violations that put patients in jeopardy or resulted in harm spiked 34% the past three years.

• Dozens of homes are cited repeatedly for serious violations.  Many of the homes cited multiple times are owned by out-of-state corporations.

• Deaths and injuries are occurring at a time of significant worker turnover. In one case, a problem home reported nursing staff turnover rates as high as 257% last year while it led the state in serious citations.

• Families are often kept in the dark about citations issued after the deaths of their loved ones. Four families learned from the Journal Sentinel that serious citations had been issued months and even years after their loved ones were buried. 

Uunprecedented growth and profits in the industry is expected to continue. Last year, the federal government spent about $75 billion on nursing home care through the Medicare and Medicaid program.

The ownership and operation of Wisconsin nursing homes has changed dramatically. Locally owned mom-and-pop operations have given way to out-of-state for profit corporations that own clusters of homes. 

Health care experts cite other factors that have affected nursing home care.   The increase in pressure iulcers are a major concern and a leading indicator of neglect.   Pressure ulcers occur when nursing home residents are left in one position too long. The ulcers get worse when people are forced to lie in their own waste which is common in uunderstaffed facilities.  Without immediate attention, the ulcers can be life threatening.

High turnover rate is an major problem.  The aides do not get paid well and are typically asked to do the work of 2 or 3 aides.  Most aides don't stay at one facility for long. The Journal Sentinel found that turnover for full-time nursing assistants at Wisconsin nursing homes can be as high as 200%, with an average of 42% last year.   Many nursing assistant jobs start at less than $9 an hour.

"It's a hard job, but it's better than working at McDonald's," said Jim Wilson, administrator at Oak Park Nursing and Rehabilitation in Madison.   The turnover of full-time professional nurses who monitor residents' care is also high. Among the homes cited repeatedly for serious violations, the turnover rate for full-time registered nurses averaged 57% last year with some homes reporting turnover as high as 300%. The state's average turnover for full-time registered nurses in all nursing homes was 32%.

Staff turnover can directly affect care, said Julie Eisenhardt, a spokeswoman for the union representing nursing assistants. Inspection records back that up.

Sava Senior Care, a Georgia-based corporation, operates 185 homes nationally. Two of its four homes in the state have been cited with serious violations at least three times since 2005.
Even when large fines or other enforcement actions are imposed against nursing homes after serious injuries or deaths, families might never know about them. Neither federal nor state law requires that families be notified.

A Journal Sentinel analysis found that nursing homes in Wisconsin were cited for poor care after the deaths of 56 residents since 2005. But Nursing Home Compare doesn't offer any details about those deaths.   The Web site also doesn't mention anything about corporate ownership, meaning that consumers would be unable to determine if the nursing home was owned by an out of state corporation or even one with a history of violations and fines.  "Figuring out who is accountable for poor care can be very difficult," said Alice Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform. "Consumers often don't know who owns and operates a facility. Unless a facility tells them, there is no public way to find that out."   For consumers, knowing who owns a home is important if they want to determine whether the same problems are showing up in multiple homes owned by the parent corporation.


The number of nurses and aides on staff to help residents is a key factor in determining whether quality care is being provided, according to experts.   "The higher the staffing, the better the quality," said Charlene Harrington, a professor of sociology and nursing at the University of California in San Francisco.   Staffing numbers provided by Nursing Home Compare are merely a two-week snapshot from the most recent inspection - and in an industry that has widespread staff turnover, those numbers can't always be trusted, Hedt said.

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S.C. to post Medicaid payments to doctors, nursing homes online 

South Carolina is now posting how much the local nursing home or doctor gets in Mediciad reimbursements.

"We are pleased to be able to offer the public a way to track how their money is spent in the Medicaid program," Emma Forkner, director of the state Department of Health and Human Services, said in a statement. "This kind of spending transparency is key to ensuring accountability from government agencies and those who get paid by them."

The move by DHHS, which administers the $5.4 billion Medicaid program, will help DHHS locate "unusual billing patterns"  and hopefully detect fraud.  

The site also provides information about dentists, hospitals and any of the other nearly 30,000 health care providers in South Carolina who participate in the Medicaid program. It includes their reimbursements as well as the number of patients they saw. More than 800,000 South Carolinians receive Medicaid, the health insurance program for the poor and disabled.

To access the data, go to http://www.dhhs.state.sc.us/dhhsnew/Transparency.asp and click on Medicaid Transparency Database.

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Pantagraph.com had an article about a Bloomington nursing home paying a reduced $14,500 fine for failing to protect residents from a sex offender who was a patient at the facility.  This is outrageous and shows why lawsuits are necessary to insure that nursing homes are held accountable for their negligence and gross stupidity. 

Asta Care, 1509 N. Calhoun St., failed to screen a male resident who made inappropriate sexual advances to staff and two mentally disabled residents. The acts were noted in nursing records dating to October 2006 at the 117-skilled bed facility but were ignored by management.  The man, who was identified as a sexual offender,  was allowed to remain at Asta Care even after complaints were made by staff. 

Clearly this situation was avoidable if the nursing home simply checked the man's background.  It is shocking that the nursing home only had to pay a small fine for such outrageous conduct.

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Arizona Daily Star reported an investigation into the lack of investigation of neglect and abuse in Arizona nursing homes.  The investigation was bold and tragic and led to the reopeing of several complaints, and the conclusion that Arizona fails to protect elderly and vulnerable nursing home residents.  Below are excerpts from the story and investigation.

tAnita McEvoy put her 92-year-old mother in a Tucson nursing home so she wouldn't get hurt as Alzheimer's disease took its toll. Instead, her mother shivered in bed while nursing aides took no notice. She died of hypothermia complications.

Another elderly woman, who couldn't see well and trusted nursing aides to bathe her, did not know they used a cell phone camera to photograph her in the shower, then went to the nursing station to show the photos and laugh about them with others.

And in a third local nursing home, a nursing aide assigned to feed a confused, 84-pound woman withheld a drink and demanded that the woman say "please" and "thank you," laughing while the woman kept asking: "What do you want? Who the hell are you?"

These cases and others over the past three years have this in common: State regulators did nothing about them.   Until Friday — when investigators reopened one of the cases as a direct result of the Star's questions.   The inspectors showed a consistent pattern of weak enforcement.
Only 15 percent of the time did they substantiate allegations of abuse, neglect or other problems in how the homes cared for some of our most vulnerable people.

The Star reviewed nearly 1,000 citations for safety problems and more than 1,100 complaints of poor care to the Arizona Department of Health Services in Pima County's 22 nursing homes in the three years ending in 2007.  The review mirrors what federal auditors have found nationally: State inspectors miss violations, underrate the severity of the offenses, and allow homes to yo-yo in and out of compliance.

The Star's investigation also reveals:
● The state blew its own investigation deadlines in three out of every four cases, often compromising the findings because patients and staff members are no longer around. The median case is 72 days late.
● The state doesn't give you enough information to determine whether a home is giving consistently good care. The public can't see the patient's side of any given complaint. You can't see reports the nursing homes make when a patient is harmed. And the only snapshot of how a home is performing is up to 18 months old in some cases.
● The state fined poorly performing homes only 24 times in three years, even though it wrote 958 citations. Until recently, the fines were typically so small that even your next-door neighbor could pay them — usually not much more than $1,000.
● Unlike other states that have set precise staffing standards, Arizona adheres to a vague requirement of "sufficient" staffing. That standard, set by the federal government 20 years ago, is notoriously difficult to assess.
● Unlike doctors, nursing homes don't have to disclose if they've paid out judgments or settlements. Dozens of cases have been settled secretly. It could become even harder to learn about improper care, because homes are getting patients to promise not to sue if something goes wrong.
● Because the state rarely substantiates complaints, sometimes staffers who are fired at one nursing home after being accused of abuse or neglect can be hired right away at another.

 

Continue Reading...

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The North Country Gazette has an article about Eden Park nursing home in Glen Falls, NY.  It appears that the ursing home never registered with the State and therefore is doing business illegally.

On Sept. 19, 2007, according to the state Department of Health, Certificates of Need were issued to Glens Falls Crossings LLC  for the operation of the nursing homes doing business under the Eden Park name.   However, the DOS Division of Corporations told The North Country Gazette, there is no record of a limited liability company under the name of Glens Falls Crossings LLC “nor do we have a record of an assumed name filed under the name of Eden Park Health Care Center."

The Warren County Clerk’s office says there’s no record of Glens Falls Crossings LLC doing business in the county.

Prior to NCG’s article, if one performed a “Google” search for Glens Falls Crossings, they were led to a website at www.glensfallscrossings.com which said it was “under construction” and to “check back soon”. The website was supposedly “created” by Creative Genius of Saratoga Springs and the domain was registered by National Health Care of Lynbrook, LI in June 2007.

The domain registration says the title of the website is “Glens Falls Crossings Center for Nursing and Rehabilitation”, a non-existent entity with the Department of State. The domain registration says it is affiliated with Cold Spring Hills Center for Nursing and Rehabilitation which specializes in “skilled nursing services for patients and families seeking long term care with dignity and respect for their individualized needs”. But Cold Springs officials say they’ve never heard of it.

How can one do business in the state without being legally registered, especially a health care facility?

In the state of New York, all LLC’s formed or qualified to do business in the state, are required to publish a notice of formation. This requirement does not affect the good standing status of the LLC; however, an LLC is required to complete this requirement in order to have access to the New York State court system. The publication is made at the county level in two newspapers as assigned by the local county recorder, for six consecutive weeks.

According to the Department of State, the four “Crossings LLC” entities, supposedly operating Eden Park nursing homes in the state, are not registered with the state as required.   Eden Park has obtained its certificate of need from the state DOH to operate the facility under a bogus legal entity that is not registered with either the state or county.

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U.S News & World Report has an article on the proposed Nursing Home Reform Bill.  Below is a summary of the article.

The byzantine world of the corporate nursing home industry may soon become a whole lot clearer. Republican Sen. Chuck Grassley and Democrat Sen. Herb Kohl seek to force nursing homes to provide more information about ownership and accountability.

The Nursing Home Transparency and Improvement Act would force nursing homes to clearly state ownership—something that has become increasingly complicated to figure out, as private investment groups have bought up nursing homes and enveloped them in labyrinthine legal structures. The opaque ownership makes it difficult for regulators to identify parties responsible for poor care and unfairly shields owners from complaints of neglect and abuse.

The bill also seeks to standardize complaint forms, improve reporting on staffing information, and replace some self-reported information with that gathered by independent audits. The primary goal is to make it easier for the public to compare nursing homes, a growing concern as baby boomers age.

The American Association of Homes and Services for the Aging, an industry group that represents not-for-profit nursing homes, applauds the bill.  The nonprofit sector is already required to produce information about finances and ownership to the IRS to qualify for its tax status.

The fight over nursing home reform will continue as the bill works its way through Congress. Proponents like the bill's chances, in part because it's authored by the respected Grassley, who is the senior Republican on the Senate Finance Committee.  Even the AAHSA wants some provisions removed, such as the bill's call for an increase in civil penalties of up to $100,000 for a deficiency resulting in death. Delays likely to come from those and other proposed changes mean, for those waiting for nursing home reform, it could be 21 years and counting.

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Seniorjournal.com has a great summary of the bill introduced by Senators Kohl and Grassley aimed at improving the quality of care in nursing homes with more and better information for consumers on the Nursing Home Compare Website published by The Centers for Medicare & Medicaid Services.   Supporting the bipartisan bill are the Service Employees International Union (SEIU) and the National Citizens’ Coalition for Nursing Home Reform (NCCNHR).

The bill:

? Enables the residents and the government to know who actually owns the nursing home

? Strengthens accountability requirements for individual facilities and nursing home chains, including annual independent audits for nursing home chains

? Improves Nursing Home Compare by including a nursing home’s ownership information, the identity of participants in the Special Focus Facility program, a standardized complaint form and links to nursing home inspection reports

? Provides more transparency of a nursing home’s expenditures by requiring more detail in cost reporting

? Provides for improved reporting of nurse staffing information so that apples-to-apples comparisons can be made across nursing homes

? Brings uniformity and structure to the nursing home complaint process by requiring a standardized complaint form and complaint resolution processes that includes complainant notification and response deadlines

? Strengthens available penalties by making them more meaningful. 

Instead of imposing civil money penalties (CMPs) up to $10,000, the Secretary would be able to impose a range of penalties of up to $100,000 for a deficiency resulting in death, $3,000-$25,000 for deficiencies at the level of actually harm or immediate jeopardy and not more than $3,000 for other deficiencies. 

The Secretary would be able to reduce CMPs for facilities that do not appeal CMPs and for self-reporting deficiencies below the immediate jeopardy level or the actual harm level if the harm is found to be a “pattern” or “widespread” or those resulting in death. 

Penalties must be collected within 90 days, following a hearing.

? Equips the Secretary with tools to address corporate-level problems in nursing home chains by giving the authority to develop a national independent monitor program specific to multistate and large intrastate nursing home chains

? Provides greater protection to residents of nursing homes that close by requiring advance notice of the closure as well as the development of a transfer and relocation plan of residents

? Requires a study on the role that financial issues play in poor-performing homes

? Requires a study on best practices for the appointment of temporary management for nursing homes as well as barriers

? Requires a study on barriers to purchasing facilities with a record of poor care

? Authorizes demonstration projects for nursing home “culture change” and for improving resident care through health information technology

? Improves staff training to include dementia management and abuse prevention training as part of pre-employment training

? Requires a study on increased training requirements either in content or hours for nurse aides and supervisory staff

Hopefully, this bill will pass Congress and get proper funding in the budget.

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Nursing home operators with severe care deficiencies could face civil money fines up to $100,000 - 10 times the current maximum - under a new bill set to be introduced today in the U.S. Senate.

Federal health officials also will develop a national monitoring program for addressing corporate-level problems among nursing home chains, according to provisions of the "Nursing Home Transparency and Improvement Act of 2008"  supported by Sens. Herb Kohl (D-WI) and Charles Grassley (R-IA)

Nursing home transparency is a main focus of the bill, which would add information on facility ownership, special-focus facilities, standardized complaint forms and nursing home inspection reports to the Nursing Home Compare Web site. It also would empower the Department of Health and Human Services secretary to develop a national independent monitoring program that would oversee large nursing home chains.

Hopefully, enforcement of Resident's Rights and prevention of neglect and abuse will start to become a national political issue before the huge influx of baby boomers need nursing home care.  I am sure the corporate lobbyists for the industry will delay or gut the final legislation.

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Here is a link to the list of nursing homes that are failing in providing good care for pressure ulcers and physical restraints.  There are over 50 nursing homes located in South Carolina on this list.  South Carolina can certainly do better.  Pages 81 and 82 list the South Carolina nursing homes on the list.

 

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Des Moines Register has a great article on Senator Grassley's comments and complaints about how states investigate nursing home abuse and neglect.  He is calling for a federal investigation into the way states respond to complaints of poor nursing home care.

"I have an obligation to protect Iowans, and all Americans, from substandard nursing care," the Republican senator from Iowa said in a letter Thursday.  Grassley criticized Iowa's nursing home inspectors for failing to thoroughly investigate a complaint involving Waterloo's Ravenwood Nursing and Rehabilitation Center.

In August 2006, Maizie Bickley was an 89-year-old resident at Ravenwood. Nurse aide Connie Rust called Bickley's daughter, Sandra Bickley, one night to report concerns that Maizie Bickley was very ill and wasn't being properly evaluated or treated by the nurses.  Within hours of Maizie Bickley's arrival at the hospital, she was diagnosed with a bowel obstruction, an infection and dehydration.

The facility fired Rust, the aide that told the family the truth citing a company policy that prohibits conduct "that results in serious negative public relations." I guess being caught providing substandard care is considered bad for "public relations" but it is worse for the neglected resident!

Sandra Bickley was furious, particularly when the Iowa Department of Inspections and Appeals looked into Ravenwood's care for her mother and found no problems. She complained to Iowa Citizens' Aide Ombudsman William Angrick and to Grassley. 

Dean Lerner, who heads the state inspections department, asked the federal Centers for Medicaid and Medicare Services to do its own review of his agency's work on the case.  That federal review concluded that state inspectors didn't conduct a thorough investigation of the Bickley case and didn't interview nurses, ambulance workers or the hospital's emergency room staff.

Grassley is asking the GAO to examine the nation's state-run nursing home inspection agencies and the manner in which they respond to complaints. He is also asking the Centers for Medicaid and Medicare Services to give him four years' worth of investigative reports dealing with state inspections. He wants to know whether the Bickley case is an indicator of a widespread problem.

Although certified nurse aides have relatively little training compared with registered nurses, it's the aides who provide most of the hands-on care in nursing homes. But they typically are prohibited from sharing concerns about quality of care with residents' family members.

"But the problems with nursing homes are widespread," she said. "We're basically just warehousing our senior citizens in this country. Too many homes are owned by corporations, and for them the bottom line is profit."

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Here is an article about a nursing home in Arizona losing its Medicare and Medicaid funding because of patient neglect.   This action is the only one the multi-chain corporation understand.  Government oversight must be increased and serious consequences of neglect must be felt by the corporations.

Some Evergreen Foothills Health and Rehabilitation Center residents would have to be relocated to a facility capable of providing good care. The state is working to move those patients.

Arizona Department of Health Services records paint a disturbing picture. Problems cited include: failing to investigate injuries to rule out abuse; failing to provide regular catheter cleansing for one patient; and failing to notice when one patient had three broken ribs.

Evergreen's corporate defense attorney stressed that, although Medicare and Medicaid funding will officially be cut next month, the state is allowing the center to remain open for now.  I am sure that is a relief to the neglected residents who remain.

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Clark Kauffman, staff writer for DesMoines Register wrote the following review of recent nursing home fines in Iowa.

Clearview Home, Mount Ayr:
A nurse aide was improperly transferring a resident who had a long-standing, serious head injury when the two lost their balance and the resident fell face-first to the floor. The resident was treated at a hospital for broken teeth and facial lacerations, then returned to the home. The resident died the next day. The home was fined $10,000.

Denison Care Center, Denison:
A resident was injured while being transferred, suffering spiral fractures in both legs, but was not taken to a hospital for three days. At the time of the accident, the resident told workers, "You broke my leg." The resident died at the hospital. A physician concluded the accident and injuries were the cause of the resident's death. The home was fined $10,000.

Eldora Nursing Home, Eldora:
A resident with a history of respiratory problems was found dead on a floor one morning. Employees said they had not checked on the man for at least nine hours, even though the resident was to have been checked every two hours. The home was fined $10,000 for failing to provide a safe environment. Three months later, the home was fined $300 for the same type of violation. In that instance, a resident had been physically attacking and threatening other residents for several months. Five months later, the home was again cited for failing to provide a safe environment.

The Manor, Malvern:
A physician was to be contacted if a resident with end-stage liver disease became drowsy or lethargic. Nurses documented that the resident was "noticeably lethargic" and napping in the lobby, but they did not contact the doctor. A nurse allegedly told a concerned co-worker that the resident was "going to die anyway." Several hours later, an employee noted that the resident was still in the lobby and was dead. A doctor told inspectors the resident might have lived had he been contacted. The home was fined $10,000.

New Homestead Care Center, Guthrie Center:
Six workers reported to managers and supervisors that a male employee had committed multiple acts of abuse and neglect against residents. Managers did not act on those concerns, which allowed the abuse to continue. In one instance, the man allegedly put a chair against the door of a female resident's room while he was inside. Another worker forced her way in and saw the employee bent over the mentally disabled resident, who was partially undressed and bleeding from her vagina. The man turned his back on the other worker and claimed he was cleaning the resident, but he had no washcloths, towels or other supplies. The home was fined $7,000. Eleven months later, inspectors returned to the home and filed a 64-page report of violations.

Park Place, Glenwood:
Four workers noted that a mentally retarded female resident was moaning and groaning in pain one night after having refused food and medication for days. The workers repeatedly asked the nurse on duty to check on the woman, expressing concern that the woman was dying and in serious pain. The nurse did not respond or contact a doctor. Hours later, the woman was found dead, face down at the foot of her bed. Two workers alleged the nurse was often talking on her cell phone or text-messaging her boyfriend. The home was fined $10,000.

Risen Son Christian Village, Council Bluffs:
A resident was placed in a bed with a broken side rail and fell to the floor, suffering a broken leg. The resident was taken to a hospital and died. The fall was the underlying cause of death. Several workers were aware the side rails on the bed were not working properly. The home was fined $10,000.

Scottish Rite Park, Des Moines:
A female resident fell in a shower, causing a serious, overlapping break in the bones of one leg. At the time, the woman told workers, "I guarantee you my leg is broken," but none of the employees notified the woman's family or doctor, or ordered an X-ray, until the next day. Three workers told inspectors they were fearful of losing their jobs or state licenses. The resident later died, and the home's medical director told inspectors the death was directly related to the fall. The home was fined $10,000.

Windmill Manor, Coralville:
A resident was entering other residents' rooms, blocking their exit and then hitting and threatening them. One of the victims tearfully told inspectors she was afraid of the man and wished she could live somewhere else. The director of nursing told inspectors she was aware of the attacker's history but said the victim who complained was "over-dramatic." While inspectors were at the home, they noticed the attacker was sleeping in the nurses' station. A worker explained that is where the man stayed, otherwise he would enter the rooms of other residents and "make them scream." The home was fined $500. Two weeks later, inspectors were back at the home investigating a death. A resident had been admitted to the home after a leg amputation. While at the home, the resident's skin deteriorated. The director of nursing never looked at the wounds. Eventually, the resident was hospitalized and doctors alleged the home had failed to treat a large, open sore. The resident was diagnosed with an infection, developed complications and died. The home was fined $10,000.

Clark Kauffman also has an excellent article about how the nursing home lobbyists have limited the amount of fines for neglect and abuse to a maximum of $10,000.  Continue reading for a brief summary.

Continue Reading...

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The Hartford Courant has an article about proposed reforms in nursing homes by the Connecticut Ombudsman's office.  I wish the South Carolina Ombudsman's office would play a proactive role in protecting resident's care and preventing neglect.  Below is a summary of the article.

Connecticut's long-term care ombudsman is proposing reforms in oversight that would protect residents who complain about poor care from retaliation and encourage state agencies to monitor and evaluate the performance of chains, rather than just individual homes.

The program outlined a dozen reforms, including protections for residents who complain about poor care such as preventing nursing homes from issuing involuntary discharges to people who file complaints for at least a year following the complaint.

The ombudsman's office also wants the Department of Public Health to impose "significant sanctions" when patient-care deficiencies result in death, and to weigh "common ownership and management" as a factor in imposing penalties against corporate operators. 

The recommendations were prompted by revelations about the troubled record of one of the state's largest nursing-home chains, Haven Healthcare, which filed for bankruptcy in November and faces a federal fraud investigation. Some of the chain's 15 Connecticut homes had escaped severe sanctions despite repeated citations for serious patient-care deficiencies resulting in death. The chain also defaulted on millions of dollars in bills for supplies and services, while its owner used corporate assets for personal profit.

Democratic state senators proposed strengthening state oversight of nursing homes and boosting staff levels. 

The ombudsman's office wants to require more financial "transparency" from nursing-home corporations, including disclosures of detailed information about related business entities. Owners shield excessive profits by diverting money to related ventures without detailing those transactions.

Other proposals call on the state to more carefully review the public-health and financial records of any new owners or managers of nursing homes or assisted-living facilities, and for "improved communication" among state agencies charged with overseeing elderly care.

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A nursing home in Squirrel Hill was fined more than $20,000 after being accused of restraining patients to their beds.  According to Health Department surveyors, patients at the Wightman Street nursing home were restrained, but there was no documentation by doctors showing the restraints were necessary.

According to the inspection report, one patient was found with a seat belt wrapped tightly around his chest, on the floor in front of his wheelchair.  The facility failed to investigate the incident.

A health department official said the facility used the restraints far too often. Typically, restraints are used on residents to prevent them from falling out of bed or wheelchairs.

Here is the full article.

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There is a great article at Tennessean.com about dozens of deficient Tennessee nursing homes that have been closed or fined as a result of neglect including drug dealers visiting The Cornelia House nursing home to sell crack to employees and residents; at Mitchell Manor, patients went without necessary pain medication for a week because the facility was out; and at McKendree Village, staffing shortages caused multiple problems, such as one patient lying in his own feces for 3½ hours, despite pushing the call light five times.

"Things aren't right here," one Cornelia House resident told a state inspector. "Residents are buying drugs almost every night. … Staff are aware but don't do anything. The patients are left wet and not taken care of." 

The 159-bed Cornelia House and the 42-bed Mitchell Manor have closed since losing tax payer funding. The 300-bed McKendree is still open to private-pay residents, but 200 of its residents dependent on federal funding must find a new place to live by Dec. 29.   However, plenty of nursing homes in Tennessee have been identified as having serious violations without losing funding. 

While lots of facilities have been cited with these serious violations, the facilities that lost their funding were unable to fix the problems within the reasonable time given or were unable to stay in compliance.

"These facilities were afforded the same number of days as others across the country to develop and implement a plan to correct the violations, maintaining an appropriate standard of care for residents," said Christy Allen, assistant commissioner of the Tennessee Department of Health, Bureau of Health Licensure and Regulation.

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Here is a link to an article that discusses a hefty fine for a facility that neglected a resident.

A Riverside County nursing home was fined $100,000 for the death of a 91-year-old woman who was dropped on her head.  Citrus Nursing Center in Fontana was cited last month for failing to provide patient safety, according to the California Department of Health.

The nursing home is owned by Sunmar Healthcare in Brea. A call to owner Frank Johnson on Saturday was not returned.

The elderly patient was injured on Feb. 24 as a nursing assistant improperly tried to transfer her from a wheelchair to a bed without help, according to a health department citation. She died nine days later.

The home also was fined a total of $25,000 last year in connection with the 2004 death of a patient who died from a bacterial infection and for failing to contact a doctor about a diabetic patient whose blood-sugar levels had reached unsafe levels.

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Here is an excerpt from a recent article in the Conservative Wall St. Journal.

Last month, health inspectors in New York City shut down Serendipity, an upscale ice cream parlor. Though the closing made headlines, it is a common occurrence for less-famous eateries charged with violations like unclean cutting boards and floors, workers who fail to clean their hands, and improper food handling that could lead to bacterial contamination.

Restaurants in New York are inspected, without prior notice, once a year. In Los Angeles, inspections are done three times a year, and restaurants must display their grade near the front door. After L.A. instituted this inspection system in 1998, the number of people sickened by food-borne illnesses fell 13%, according to the Journal of Environmental Health. Other cities are now following L.A.'s lead.

Why aren't hospitals {and nursing homes} held to the same rigorous standard? The consequences of inadequate hygiene are far deadlier in hospitals than in restaurants. The Centers for Disease Control and Prevention estimate that 2,500 people die each year after picking up a food-borne illness in a restaurant or prepared food store. Forty times that number -- 100,000 people -- die each year, according to the CDC, from infections contracted in health-care facilities.

Data recently published by the Journal of the American Medical Association show that infections from just one type of bacteria -- methicillin-resistant Staphylococcus aureus (MRSA) -- kill about twice as many people in the U.S. as previously thought. The finding is based on lab tests, not on what hospitals report. If the same methodology were used to quantify deaths from all hospital infections, the death toll would likely be much larger than 100,000.

These infections are caused largely by unclean hands, inadequately cleaned equipment and employee's contaminated clothing that allow bacteria to spread from patient to patient. In a study released in April, Boston University researchers examining 49 operating rooms at four New England hospitals found that more than half the objects that should have been disinfected were overlooked by cleaners.

Testing surfaces is so simple and inexpensive that it's used routinely in the food industry. Is it more important to test for bacteria in meat processing plants than in operating rooms?

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The Associate Press had this story today.   Fifty-six nursing homes are among the worst in their states and are being called out in an effort to goad them into providing proper patient care.

Lawmakers and advocacy groups complain that too many facilities get cited for serious deficiencies but don't make adequate improvement, or do so only temporarily.

The homes in question are among more than 120 designated as a "special focus facility." CMS began using the designation to identify homes that need more oversight.   The homes on the list got not only the special focus designation, but also registered a lack of improvement in a subsequent survey. 

There are about 16,400 nursing homes nationwide. About 1.5 million elderly people live in nursing homes. Taxpayers spend about $72.5 billion a year to pay the cost of nursing home care.

The AARP also applauded the administration's action.

"People in nursing homes have a right to know how well they're performing," said David Certner, director of legislative policy for AARP, an advocacy group for people 50 and older. "Their families certainly have a right to know what kind of care their relatives are receiving and if that care is substandard."

Here is the link to the list.

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A nursing home abuse bill, the Elder Justice Act, has been under consideration in Congress but has yet to be passed. Although nursing home and elder abuse are serious and growing problems, the nursing home abuse bill has never even been voted on. While no one in Congress opposes the nursing home abuse legislation, few are trying to push it through the legislative process.

But the issue of nursing home abuse should be getting more attention, just based on the shear numbers of elderly affected by this crime. Though it concedes that the true number is probably much higher, The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse.

According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to having witnessed, and even participating in, acts of abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse. There are nearly 1.4 million Americans living in nursing homes right now, and that number is expected to more than double in the next decade. As it does, advocates for the elderly and disabled fear that incidences of abuse will continue to climb as well. 

The Elder Justice Act would set up separate elderly justice offices in the U.S. Departments of Justice and Health and Human Services, provide $400 million for state adult protective services over four years and create a federal coordinating committee among agencies to monitor and direct the government’s efforts. The bill would also establish forensic centers around the country to probe elderly abuse cases and give local prosecutors more support in bringing cases. And it would penalize nursing homes if they did not report crimes swiftly. 

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Staffing became an issue in the recent Kentucky Governor's race.  Democrat Steve Beshear said that Kentucky needs to consider requiring minimum staffing levels at nursing homes, but Gov. Ernie Fletcher said the corporate owners should be allowed to determine how many nurses they hire.

Last night, Beshear said Fletcher's administration has failed to protect seniors, citing a news story that indicated the number of citations for nursing homes has declined since the Republican became governor in 2003.

"We don't have enough inspectors to go and enforce" laws that apply to nursing homes, said Beshear, a Democrat.

"I think it's time to look at minimum staffing numbers," he said. "We've got to make sure the profit motive doesn't interfere with the care motive."

Fletcher said the state doesn't need to set minimum numbers of nurses for nursing homes saying that the state can ensure adequate care in other ways.

"We've closed nursing homes that needed to be closed," he said.

See article here.

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The New York Times recently had an interesting article regarding Congressional leaders questioning the policy and practice of the insurance industry in long term care settings.  The top-ranking Republican on the Senate Finance Committee has asked 11 long-term care insurance companies to explain “troubling data” regarding how policyholders’ claims are handled and paid.

Senator Charles E. Grassley of Iowa, referred to data collected by the National Association of Insurance Commissioners, which indicated that nationwide complaints about long-term care insurance rose 92 percent from 2001 to 2006. The data also indicated that complaints involving claim denials resulted, in a majority of cases, in reversals that favored consumers.

“This is a pattern of error not typically found in other lines of health-related insurance,” the association wrote.

Senator Grassley has asked the largest long-term care insurers to provide detailed information on how policyholder claims, inquiries and denials are handled and whether employees receive rewards for denying claims.

This week, Mr. Grassley also asked the Government Accountability Office to examine how private equity ownership had affected the quality of care in nursing homes. In particular, Mr. Grassley asked the agency to examine how many nursing homes had been bought by private investment groups and how conditions had changed after those homes were acquired, and to examine the number of health and safety deficiencies cited by regulators at those homes.

A report in The Times last month said that private equity firms had bought thousands of nursing homes and then often cut expenses and staff, sometimes below minimum legal requirements, to increase profits.

The nursing home industry has also faced questions recently. The Service Employees International Union, one of the biggest labor unions, sent letters to Congress this week asking lawmakers to examine the proposed acquisition of HCR Manor Care, the nation’s largest nursing home chain, by the Carlyle Group, a private equity firm. “Profit for investors cannot come at the price of patient safety and care,” the union said in a statement.

The acquisition of Manor Care is not yet complete. But, the Carlyle Group said, “We expect to maintain the same high quality care that seniors and their families have come to expect.”

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U.S. Senator Barack Obama today released a statement on the report in the New York Times on nursing homes.

"The news that some private equity firms have been boosting profits at the nursing homes they own by cutting essential staff and compromising the quality of care for our seniors is unconscionable and unacceptable. America's workers and America's seniors deserve better, and the American public deserves to know exactly what's going on in these nursing homes."

'I led the fight in Illinois to pass the Hospital Report Cards Act that required hospitals to disclose details on nurse staffing and the quality of care so that the everyone was aware how well their health care system worked. When I'm President, this kind of transparency will be a part of my universal health care reform that provides every American with affordable, quality health care."

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I wish South Carolina enforced the nursing home rules and regulations and issue fines when neglect has occurred. To my knowledge, SC has never fined any "for profit" nursing home.

A nursing home was fined $100,000—the most severe penalty under state law—after investigators ruled that poor health care led to the death of a 76-year-old patient.
Pleasant Care Convalescent of Petaluma operates a 54-patient facility where a woman died March 12 from an infection, said Norma Arceo, a spokeswoman for the California Department of Public Health.

The woman developed an infection and died from complications in a hospital eight days later, Arceo said. Records showed the patient had extensive cavities and food debris throughout her mouth, causing large swelling in her neck. 

Here is the full article. 

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Below is from the SC DHEC website. DHEC is the state agency that has the responsibility to oversee and supervise nursing homes in SC.  Typically, they do nothing.

Do you have a complaint to file?
We ask that you carefully read the following information before filing a complaint. If you have supporting documents, please submit a copy - do not send originals. Listed below is the information you will need in order to mail or phone in your complaint.

Investigation and resolution of complaints are a critical Division of Health Licensing responsibility. A complaint is defined as an allegation that relates to a condition, events relative to a licensed activity, or to an activity subject to licensure. The Department is required to investigate any written or verbal complaint which indicates that there may be a violation of the licensing standards.

Any individual making a complaint against a licensed activity or provider may do so anonymously. If a complainant reveals his/her identity and requests confidentiality, the Department will not disclose the complainant’s identity unless mandated by state or federal law.

Your complaint will be assigned to an inspector who will determine if the Department can assist you. Written acknowledgement of our receipt of your complaint will be sent to you. Because of record keeping requirements and the need for accuracy, we ask that your complaint be submitted in writing, however you may call us with your concerns.

To generate an investigation, the Department must receive a complaint from an individual regarding an expression of discontentment, concern, and/or distress which may involve the conduct of the staff, conditions of the activity, care of the clients, etc., in an activity licensed by the Department. These expressions of concern could also involve a potentially unlicensed activity which may be operating illegally. In all instances, there must be an identification of a possible violation of a licensing standard.

Once an investigation is completed, the inspector will send a written report to you. Please contact the Department if your complaint is resolved before you hear from us.

The Department cannot always resolve complaints to the satisfaction of all complainants; however, we will investigate the complaint based on the facts, the appropriate regulation(s), and advise you of our findings. Our complaint inspectors are knowledgeable about the regulations and have access to attorneys who provide legal guidance for the staff.

Complaints regarding concerns not under the jurisdiction of the Department may be referred to another state agency or local authorities as appropriate.

Complaints concerning abuse - physical, sexual or psychological, or financial exploitation, or neglect or abandonment of a resident, (whether the incident occurred inside or outside of the facility) will be referred to the Lieutenant Governor’s Office on Aging, (800) 868-9095.

Complaints concerning Medicare and Medicaid should be referred to the Department's Certification Division.

It is preferable that you try to resolve your own complaint before contacting the Division of Health Licensing. However, if you have exhausted your efforts to resolve the problem without success, contact us for assistance.

The Department receives a large number of complaints which require varying lengths of time to resolve. Your patience is appreciated and we will contact you as soon as possible.

Jim Perrow, Customer Service
DHEC Health Licensing
2600 Bull Street
Columbia, SC 29201
(803) 545-4370
(803) 545-4212 (Fax)

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 At a hearing this month concerning the state of the nursing home industry 20 years after the landmark Nursing Home Reform Act (better known as OBRA ‘87), Senate Special Committee on Aging Chairman Herb Kohl (D-WI) addressed the deficiencies of a system that has allowed some poorly performing nursing homes to escape penalties.

Testimony by the Government Accountability Office (GAO) presented at the hearing concludes that many nursing homes shown to be providing substandard care are still not being subjected to any sanctions, and are therefore not be motivated to make the lasting improvements necessary to protect the health and safety of residents.

According to the GAO, in 2006 nearly one in five nursing homes nationwide was cited for poor care or, more specifically, care that can cause actual harm to residents.

“Without question, the Nursing Home Reform Act improved nursing home care in this country. Today, many of the nation’s 16,000 nursing homes are providing adequate or excellent care. But shamefully, quite a few nursing homes are getting away with providing a lot less, putting a good number of the seniors living in long-term care facilities at risk. This is unacceptable, and raises questions about how and why our enforcement system is failing,” said Chairman Kohl. “This committee has a long history of closely scrutinizing the quality of nursing home care, and we intend to reaffirm that commitment.”

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State and federal officials announced today a $550,000 settlement in a fraudulent medical billing case against Green Valley Pavilion of Smyrna.

Members of the Delaware Attorney General’s Office medicaid fraud control unit and the U.S. Attorney’s Office determined that some of Green Valley’s employees were altering patient charts in order to get more money from the Delaware Medicaid Program.

Because the investigation showed that none of the nurses personally profited from the scheme, state and federal prosecutors pursued Green Valley for restitution due to Medicaid. After months of negotiations, Green Valley agreed to pay more than a half million dollars.

“Caregivers have been sharply reminded of their responsibilities to their patients, and nursing home owners are on notice that they will be held responsible for the acts of their employees,” said Deputy Attorney General Dan MIller, the lead prosecutor in the case. “We have already seen a drop in the amount of questionable reimbursement requests submitted to the Medicaid program.”

See article here

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An Orleans County nursing home has been fined $75,900 by the federal government for failing to comply with quality care requirements.

Orchard Manor was cited for civil money penalties based on a survey in November. Civil money penalties are given out by the Centers for Medicare and Medicaid Services.

According to The Monitor, the amount of Orchard Manor’s penalty “does not reflect a 35 percent reduction as the facility did not waive its right to a hearing as permitted under law.”

Leroy Village Green Residential Health Care Facility in Leroy, Genesee County, also made the civil money penalties list, being fined $3,412.50 for results from an October survey.

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The former owner of several nursing homes has been sentenced to 42 months of imprisonment after being convicted of health care fraud and money laundering.  Rocky Lemon pled guilty on both charges.

In addition to the prison term the owner must serve three years of supervised release after completing his imprisonment and pay more than $4 million in restitution to Medicare and Medicaid. 

From 1997 to April 2001, Lemon owned and operated more than 50 nursing homes through TLC Healthcare Inc.

Lemon admitted that he executed a scheme to defraud the Medicare Program and the Texas Medicaid Program by diverting Medicare and Medicaid money to his own personal use and benefit.

Lemon used some of that Medicare and Medicaid money to finance his purchase of nursing homes, then sold some of the nursing homes for profit and funneled a portion of the net proceeds into his personal bank and brokerage accounts.

See article here

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The Government Accountability Office (GAO) has finally concluded what we all knew to be true:  Nursing homes go unpunished for the abuse and neglect suffered by residents. See story here

Federal health officials impose only minimal penalties on nursing homes repeatedly cited for mistreatment of patients.  As a result, nursing homes cycle in and out of compliance with federal standards and pose a continued threat to the health and safety of patients.

''Some of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs,'' said the report, to be issued this week by the Government Accountability Office, an investigative arm of Congress.

The Department of Health and Human Services ''fails to hold homes with a long history of harming residents accountable for the poor care provided,'' the investigators said.

Congress established stringent standards for nursing homes in 1987. In 1998, the GAO reported that ''homes can repeatedly harm residents without facing sanctions.''  About 1.5 million people live in the nation's 16,400 nursing homes on any given day.

The GAO said federal health officials hesitated to impose fines of more than $200 a day, in part because they believed that larger penalties ''could bankrupt some homes.'' Fines are generally so small that nursing homes view them as a ''cost of doing business,'' with ''no more effect than a slap on the wrist,'' the report said.

Here is a good example where a nursing home was fined for overmedicating a resident and then officials withdrew the fine!

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Many residents are totally reliant on staff for care, and rely on the federal Medicare program to pay the bills. The problem at nursing homes is poor staffing.  I just read an article that discusses the issue and explains how and why it is a system wide problem.

The article talks about an investigation that found the staffing shortage wasn’t an oversight.  The homes and their upper management were "padding their balance sheets on the backs of helpless residents in their care".

“They were all trying to make a buck,” said Alan Peak, an FBI agent in the white collar crimes unit. The probe revealed criminal conditions at the nursing homes—residents suffering from bed sores, malnutrition, beatings, neglect—all the result of their management company’s directives to cut costs. Meanwhile, managers rewarded themselves handsomely for their efficiency.

The fraud prosecution is one of the first of its kind. While systematically cutting back on service at the nursing homes, management continued to collect money from Medicare and Medicaid for services they knew were inadequate, or in some cases not performed at all.

The management company and its CEO, as well as the nursing homes, pled guilty last fall to fraud conspiracy charges. In February, the CEO was sentenced to 18 months in prison, and the nursing homes were each fined $180,000. The company president was sentenced April 20 to two months in prison for his role.

 

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The Michigan AG is trying to stop the abuse and neglect of nursing home residents.  A Metron's Greenville Nursing Home is facing a $100,00 fine for what the Michigan Attorney General calls "quality of care deficiencies."

The penalty was imposed against Metron for bed rail issues involving several residents earlier this year. This incident follows criminal charges the Attorney General brought in February 2006 against eight employees of the Metron facility in Big Rapids. The charges stemmed from the death of Sarah Comer in January 2005.

See more information here

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In past years, the bill came close to passing but failed because of lack of support in the House of Representatives. Therefore, it is extremely important to get members of the House to co-sponsor and support the bill this year.

Please contact your U.S. Representative's office and ask for him or her to co-sponsor the Elder Justice Act, H.R. 1783. Ask them to support this bill because:

• Abuse and neglect of the elderly in long-term care settings are serious problems. (If you can, give a local example that shows this.)
• Abuse and neglect are under-reported; but even so, long-term care ombudsmen across the country receive over 16,000 complaints a year about abuse, gross neglect, and exploitation. (If you have one, substitute a statistic from your state or area that shows the amount of abuse or neglect in your local facilities.)
• The Elder Justice Act will help public agencies combat abuse against all elderly. It is the strongest legislation introduced to protect nursing home residents in the past 20 years.
• There are several ways to contact your Representative:
  Call the U.S. Congress switchboard at 202/224-3121. They will put you through to the Representative's office, and you can give your message to the person who answers the phone.
• The Elder Justice Act provides for a wide range of programs and grants to improve detection and handling of elder abuse. A number of provisions are directly related to protecting residents in nursing homes and/or other long-term care facilities. These would:
• Improve forensic investigation of elder abuse.
• Require the number of adjudicated criminal violations by facilities or their staffs to be published on Nursing Home Compare.
• Provide for a consumer rights information page on Nursing Home Compare.
• Authorize new funding to improve ombudsman capacity and training.
• Authorize a national training insitute for long-term care surveyors.
• Require operators and empoyees of any long-term care facility that receives federal funds to report "any reasonable suspicion of a crime" to law enforcement; establish fines for those who fail to report and protection from retaliation for those who do.
• Require nursing homes that are voluntarily closing to give 60 days notice to the state survey agency and provide a plan to relocate residents.
• Authorize a report to recommend legislation or administrative action to establish a national criminal background check system for nursing home workers.
• Authorize a study on establishing a national nurse aide registry.

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Woman fell nine times in 7 months, and didn't get 22 doses of necessary medications but the State only fined the home $1500. 

A resident fell nine times in seven months before anyone at her nursing home acted to prevent further falls. Her chart also describes six weeks last fall when she was behaving wildly — yelling, pacing, threatening staff and taking off her clothes, among other things. But none of her caregivers connected that to the fact that they failed during those same weeks to give her 22 doses of a drug to treat her mental illness.

For failing to provide that necessary care, Santa Rosa Care Center paid a $1,500 fine last week to the Arizona Department of Health Services, which licenses nursing homes and other elder-care facilities.
Last week's $1,500 fine was the second penalty Santa Rosa has paid since Oct. 31. The home paid $3,500 after a March 2006 complaint investigation documented that a male nurse and two other staffers were verbally, emotionally and physically abusive to seven residents.

One of the residents was kicked, another was restrained with a choke hold, another had his arm twisted behind his back, and several of the residents said staff members had yelled at them.

The purpose of a fine is "to create enough incentive to stay in compliance (with state licensing rules) but to not be so detrimental to the facility as to pull too many resources away from patient care," Wynn said.
Grabel said he thought the penalty was low, "considering what happened to the patient … If the individual had nine falls, there should have been a fall-prevention plan that was implemented for her. If there was a problem with her getting her meds appropriately, then that also should have been taken care of as part of a plan. We need to make sure that we have better care for our elderly."

See link for full story www.tdn.com/articles/2007/04/15/top_story/news01.prt

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Two formers owner of two Bronx County nursing homes defrauded the Medicaid program of millions of dollars by overcharging for services at two facilities over a six-year period.

From 1997 to 2003, Zelmanowicz, through his nursing homes, submitted bills to Medicaid fraudulently claiming that the facilities were entitled to payments for reserving or “holding” residents’ rooms during periods when the residents were temporarily hospitalized, commonly referred to as “bed holds.”

See link www.midhudsonmostwanted.com/stories/20070413-03.htm

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FRIDAY, DECEMBER 15, 2000

(202) 514-2007

WWW.USDOJ.GOV

TDD (202) 514-1888



TENNESSEE-BASED NATIONAL HEALTHCARE CORPORATION

SETTLES MEDICARE FRAUD CASE FOR $27 MILLION



WASHINGTON, DC - National Healthcare Corporation (NHC) will pay the United States $27 million to resolve allegations under the False Claims Act that the company submitted falsely inflated reports to Medicare, the Justice Department announced today. The government alleged that beginning in 1991 the company submitted nursing home cost reports that falsely claimed that facility staff members spent more time caring for Medicare patients than they actually did in order to collect additional money from the federal health care program.

The complaint against NHC alleges that the company submitted cost reports that included false claims for reimbursement. NHC, headquartered in Murfreesboro, Tennessee, owns, leases or provides services to 105 nursing homes nationwide.

"Today's settlement by the Justice Department demonstrates the government's determination to combat health care fraud by providers," said David W. Ogden, Assistant Attorney General of the Department of Justice's Civil Division.

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