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

The Wall St. Journal reported that "some of the nation’s largest health-care landlords are pulling back from nursing homes on concerns they will be less profitable in an era of steep Medicare and Medicaid cuts." Health Care REIT Inc., which leases to about 250 nursing homes nationwide, and Senior Housing Properties Trust, which is the landlord to nearly 50 nursing homes, have indicated they are greatly reducing their exposure or that they might exit the sector.

"Ventas Inc., one of the largest health-care landlords in the U.S., said it is comfortable with the approximately 300 nursing homes it already houses but won’t make major new acquisitions in the sector until there is more clarity on Medicare rates. Instead, Ventas plans to expand into assisted-living properties that aren’t dependent on government subsidies."

REIT equity investors remain attracted to nursing-home landlords, in part because of their relatively high dividend yields. Health Care REIT’s share price is up 22.6% so far this year and it pays a dividend yield of 4%, higher than the 3.3% yield for the overall REIT sector.

These entitlement programs combined make up about 90% of nursing-home revenue. If they are diminished, some nursing homes could have difficulty paying their rent.  Medicare pays for patients admitted for post-surgery rehabilitation for stays around 90 days or less. Medicaid, accounting for about 70% of most nursing-homes’ revenue, subsidizes longer stays for indigent elderly patients. The sequester will result in $11 billion in reduced revenue to Medicare providers. That is on top of an estimated $7 billion shortfall in Medicaid reimbursements nationwide last year, a 14.3% jump from 2011, according to the American Health Care Association.

Some nursing-home landlords say the market risk is overstated. If the sequester-induced cuts do occur, “We don’t believe it will have a big impact on the operators profitability,” said Craig Bernfield, chief executive and founder of Aviv REIT Inc., based in Chicago.

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In a recent interview with 60 Minutes, the man charged with killing 29 patients attempted to explain the reason behind his murderous spree. Charles Cullen was charged with 29 deaths, but he claims to have killed 40 patients total. Some believe this is a conservative estimate and that he may be responsible for as many as 400 deaths.

So why did the man who might be the most prolific killer in American history commit these crimes? He now claims that they were mercy killings, that he felt compelled to end patients’ suffering. How ridiculous.  Who gave him the right to play God?

Most of his victims were not even close to death. When reminded of this, Cullen says that there is ‘no justification’ and that he ‘felt compelled at the time.’  Cullen did express remorse for his crimes, but stated that had he not been caught, he wasn’t sure that he would have stopped. Cullen admits to killing 40 patients at nine hospitals and a nursing home. See article at Daily Mall.

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The Tennessean reported that National Health Investors which owns the national for-profit nursing home chain National Health Care settled with two nonprofit entities they created and to which they were accused of selling nursing homes at inflated prices.  In the suit the court-appointed receiver filed, the company was accused of selling failed or foreclosed homes that owed it money at inflated prices to the nonprofits it formed to maximize recovery of the loans, instead of selling the facilities on the open market.

The settlement resolves the legal dispute over fairness of the deals under which the nursing homes were sold by Murfreesboro-based NHI to the nonprofits and eventually managed by National Healthcare Corp.  The nonprofits paid more than what the homes were worth.  The settlements are designed to help reduce the nonprofits’ debt to NHI. NHI will lease the facilities in Massachusetts and New Hampshire to NHC, which "manages" them for the nonprofit.

"A Davidson County chancery judge will likely decide how to dole out $40 million in settlement money to select charities across Tennessee that will result largely from a court-appointed receiver’s sale of 14 nursing homes and other assets of the nonprofits, which are SeniorTrust of Florida Inc. and ElderTrust of Florida Inc."

 Both NHI, a real estate investment trust, and NHC, a nursing homes operator, are publicly traded companies headquartered in Murfreesboro. Along with the $44 million from NHI’s settlement of the previous dispute that involved nonprofit Care Foundation of America, the amount going to charities statewide should rise to $84 million.

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WISTV reported on another tragic case of neglect here in South Carolina. David Christmas lost his mother six months ago. He had spent years caring for her at his home before trusting Kingstree Nursing Facility to take care of her.   But they did not take care of her.  Instead, his mother ended up in a hospital bed with a broken hip with bruises from head to toe.   "My mother was placed on May the 7th of 2012," said Christmas, "and on Oct. 17th of 2012, she was dead."  Kingstree police investigated the assault to figure out what happened. Christmas says his mother told him she was attacked. All she could tell him was it was by two women.

The nursing home refuses to tell the family what happened.  And DHEC won't substantiate anything.  WISTV attempted to review DHEC records.  "We went to DHEC to see if we could look at some inspection records. We signed in and were directed to the agency's Freedom of Information Office where staffers asked us to file a formal request for some specific records
DHEC doesn't post the records online."

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A new study of Texas hospitals found that hospitals are actually getting paid money to perform faulty surgeries.  In cases where preventable mistakes occur during surgery, hospitals are getting paid more money by insurance providers, resulting in an over $30,000 additional price tag. In these cases, a preventable mistake, such as a patient contracting pneumonia, or their incision becoming infected, the patient often must stay in the hospital for additional time. What once was a three and a half day hospital stay turns into a fourteen day stay, with a much more substantial price tag that comes at the expense of the patient's insurance. While insurance companies do provide quite a bit of revenue for preventable mistakes, they do have a ‘never’ list of things that they will not pay for. This list includes leaving a sponge/instrument in a patient, or operating on the wrong body part.   See articles at Politico, Kaiser, and NY Times.

The researchers say that they don't believe hospitals are intentionally allowing preventable mistakes to occur to gain income, but they do believe that there is no incentive for hospitals to improve their quality of care. If a patient catching pneumonia results in a $30,000 bonus to the hospital, why would the hospital want to reduce the chance of patients catching pneumonia?

To combat these preventable mistakes, some hospitals and doctors are now using checklists. These checklists sound obvious, including tasks like double checking the patient's identification, body part being operated on, and if they're allergic to any medications. By using these checklists, doctors and nurses ensure that they know who their patient is, what they need operated on, and what medication they should or shouldn’t have.

Since 2004, the Joint Commission, which accredits American hospitals, has required doctors and nurses to use a short checklist to increase surgical safety and to decrease preventable mistakes. If this checklist didn’t work, how is another supposed to help?
 

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The Smithsonian Magazine had an interesting article on Thane Rosenbaum's new book called Payback: The Case for Revenge.  Fordham University law professor Rosenbaum argues that the "desire to get even is an indelible part of our nature, and that it’s nothing to be ashamed of.  In fact, he says, we’d all be better off if society makes a place for revenge in our legal system, accepting it as an integral part of justice."  Roosenbaum uses history, mythology, popular culture and recent events to “give revenge a chance.”

Rosenbaum argues "To me, there’s a greater moral outrage in not taking an eye for an eye, or in taking less than an eye for an eye. It’s the moral outrage that comes when people feel they can get away with something. We’ve been taught that vengeance is an artifact of our primitive past. But there is no justice unless people feel avenged. Criminals and wrongdoers should be made to pay back what is owed."

Vengeance by definition is proportional to the wrongdoing.  Courts need to allow “permissible, legal pathways” for vengeance.  "But I do know that to under-punish, to shortchange, is a kind of moral violation that we should find intolerable. I write about the woman in Iran who was blinded by a classmate, with acid thrown in her face. Originally the sentence was that a doctor would put acid in the eyes of the person who did that—truly an eye for an eye. This woman has been blinded and disfigured for the rest of her life, and why should the other person not experience the same thing? In the end, both the court and she decided not to go through with that remedy. Some people were relieved. But I think it at least sends a message that she was entitled to that."

He asserts "If the principles of the Constitution applied equally to protect victims as much as the accused, I would say that it is “cruel and unusual punishment” to deny victims the right to experience the reclaiming of honor that comes with punishing those who have done them harm." He continues "People come to the law when they’re at their most vulnerable, their most emotional, their most morally injured. We have to respond to them at that level. Vengeance has a purpose. It has an emotional purpose, a moral purpose, a therapeutic purpose.

"A Thane Rosenbaum courtroom is a much messier courtroom—it’s emotionally open. It’s not as clipped and canned and sanitized. It gives people an opportunity to express their grief, their loss, to speak to their pain. We don’t do that now. What I’m talking about is a much more tearful expression of justice. It’s much more honest; it’s therapeutic. There’s something very powerful in standing before your community and speaking to your loss."

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The Wall St. Journal had an interesting article on the staffing and budget problems in Texas nursing homes.  The industry's lobbying group blames the problems on cuts in Medicaid funding as profits soar.  The industry is pressuring legislators to increase the skilled nursing care Medicaid rate in accordance with Health and Human Services Commission (HHSC) recommendations.

Lobbyist Julie Sulik (Texas Health Care Association Nurse Council Chair) said  "We care for 60,000 elderly and disabled Texas seniors dependent upon Medicaid, and our facilities simply cannot continue to operate at current staffing levels if Medicaid funding remains well below the actual cost of caring for our elderly."

The Texas House of Representatives passed SB 1 on April 4 without addressing nursing home care Medicaid rates -- despite a $58 million Medicaid cut in 2011 and a $51 million Medicare cut this month. A 2013 Texas Health Care Association (THCA) survey of facilities indicates staff layoffs and wage freezes may occur if cuts remain.  "Specifically, the survey finds 84% of nursing homes may have to freeze wages, 75% may have to defer or reduce staff benefits, and 31% say they may have to lay off direct care staff in the wake of cumulative funding cuts."

Sulik noted a 4/15 Wall Street Journal story that helps detail the demographic challenge and the stakes involved:

The number of Americans 65 years and older is projected to reach 73 million in 2030, up from 40 million in 2010. Serving that growing population will require five million direct-care workers in 2020, up 48% from the 2010 level, according to U.S. government projections.

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The Nashville Post reported that National Health Investors has paid more than $26 million for two skilled-nursing homes in the Dallas area. Murfreesboro-based NHI bought the facilities from Fundamental Long Term Care Holdings, which runs care centers in more than a dozen states around the country.  NHI funded its purchase with from borrowings from its revolving credit facility.

Combined, the two centers in Corinth and Canton, Texas, are home to 254 beds. Both are less than two years old and are now being leased for 10 years by agents of Sparks, Maryland-based Fundamental owned and operated by Murray Forman and Leonard Grunstein.  NHI will take in $2.4 million in annual lease payments.

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New findings in the 2013 Senior Care Acquisition Report show investors optimistic about long term care housing.  In the nursing home and assisted living sectors, prices rose to exorbitant amounts, astonishing even seasoned investors.

This report found that in nursing homes, the average price for a bed was $60,400. Assisted living facilities were even more expensive, the average amounting to $164,000.

Executive Director of Families for Better Care said that “Assisted living facilities were a hot commodity as they ‘dominated’ the market.” These exorbitant prices would make it seem that the industry has been successful even during the recent recession and Obamacare which will hopefully lead to more money for resident care, and not the pockets of the corporate owners.

See article at Fort Mill Times.

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My name is Bonnie and I work with Best-mha-programs.com. I came across your blog and thought I’d direct your attention to our infographic, “Beyond 100: What We Can Learn from People Who Pass the Century Mark”. I think it’s something you and your community would enjoy reading or sharing. Here’s the link.

Let me know if there’s anything we can do for you. Hope you’ll keep up the great work and awesome content!

Thanks,
Bonnie Moore
 

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