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

NY Times had an article about cuts in home-care services for elderly and disabled because of budget shortfalls despite the fact that programs have been shown to save states money in the long run because they keep people out of nursing homes.

Since the start of the recession, at least 25 states and the District of Columbia have curtailed programs that include meal deliveries, housekeeping aid and assistance for family caregivers, according to the Center on Budget and Policy Priorities, a research organization. That threatens to reverse a long-term trend of enabling people to stay in their homes longer.

States that have made cuts:

Oregon, facing a $577 million deficit, was cutting home aides to more than 4,500 low-income residents.  State legislators say home care is a service the state can no longer afford. Cuts affecting an additional 10,500 people are scheduled for Oct. 1.

¶Florida placed 69,000 people on waiting lists for home or community services last year, and more than 5,700 of them ended up in Medicaid nursing homes.

¶Alabama cut housekeeping services — useful for people who can no longer do some cleaning tasks — for more than 1,000 elderly residents.

¶Arizona sliced independent living supports and respite programs for family caregivers.

¶Kansas, with a $131 million shortfall, will cut independent-living services for 2,800 people with disabilities in the next year.

In Illinois, providers of Meals on Wheels have stopped adding clients because the state was not reimbursing them.

Colorado, Mississippi, Missouri, Nevada, New Jersey, New York and Texas have all made cuts or frozen spending at a time when the elderly population — and the need for services — is growing.

In California, which faces a budget shortfall of $19.1 billion for the 2010-11 fiscal year, Gov. Arnold Schwarzenegger’s office proposed eliminating adult day health care centers that serve 45,000 people and in-home supportive services that help more than 400,000 elderly, disabled or blind residents.

Because Medicaid regulations require states to provide nursing home care to receive federal Medicaid money, legislators often have more leeway to cut from home services. Advocates for the elderly and the disabled worry that these cuts are just the beginning, because state ledgers tend to recover more slowly than the national economy.

Barbara Quirk wrote an article on The Cap Times regarding certain aspects of the Affordable Care Act.  The federal Department of Health and Human Services announced the availability of $60 million in Affordable Care Act grants to help people navigate their health and long-term care options. Through these grants, HHS’s Administration on Aging will collaborate with the Centers for Medicare and Medicaid (CMS) to encourage an integrated approach to health care and social services. It is a model that has long been recognized as essential for patients and their caregivers.

“The Affordable Care Act seeks to lower health care costs, improve the quality of health care and, perhaps most importantly, give people more control over their own care. These new grants, authorized under the new law, will help seniors, individuals with disabilities and their families get better quality care and more control. We’ve also streamlined the process for states and people who rely on these funds,” said HHS Secretary Kathleen Sebelius.

“We know how difficult it can be for caregivers and patients to try and deal with a sudden illness or chronic disease while at the same time trying to negotiate through a complex health care system to figure where you can get help. These new funds that we have bundled together will help promote better opportunities for coordination of health and long-term supports,” said Sebelius.

“When it comes to long-term health care, each patient has a unique mix of complex medical and social needs that must be considered when seeking care,” says Marilyn Tavenner, acting CMS administrator. “Our health care system can offer many options to meeting those needs from traditional nursing home care to home and community-based services. Making patients and their families aware of these options will help them make inherently difficult decisions about long-term care. The integrated program will help families make informed choices and make sure patients have more control over their own care.”

This is part of a larger nationwide effort to bring direct-care workers into positions of respect and acknowledgment by giving the patients or the families a bigger voice in decisions about working conditions and wages. Whether in a traditional nursing home setting or an in-home setting, a critical factor is continuity of care.

Basic to any effort to improve long-term care is retaining, supporting and strengthening this core group of personal care providers.

Affordable Care Act funds will be available to states, area agencies on aging and Aging and Disability Resource Centers to coordinate and continue to encourage the use of tested Care Transitions Program models that integrate the medical and social service systems. This will smooth the transition of individuals from hospitals and nursing homes back to their communities and homes.

Barbara Quirk is a Madison geriatric nurse practitioner. Tandbquirk@aol.com
 

The Jackson Sun News had an incredible story about a nursing home who hired a woman with a long history of fraud and forgery.  Sheila Watson was arrested and charged with one count of identity theft, four counts of criminal simulation, four counts of forgery, one count of criminal impersonation and one count of theft over $1,000.  Watson was the social services director at Bells Nursing Home.  Watson is also an ex-convict who has used at least half a dozen different names in a long history of state and federal fraud, forgery and theft convictions.

The investigation into Watson — who has worked at the nursing home since July — began when the nursing home received a call from a state agency.  The investigation is still ongoing but "They said she did a great job and was a good employee," Klyce said. "We've looked at her computer and couldn't find any evidence at this point."

When the Sheriff's Department began investigating, authorities soon discovered Watson's job application was only the tip of the iceberg, he said:

She had borrowed money from the Bank of Crockett County using false documents. She was wanted in Iowa on charges of theft over $10,000. She was on probation but was using a different name and job description to report to her probation officer.

Watson was arrested as Sheila F. Hayes in November 2002 on federal charges of forgery, theft of property and identity theft, according to The Jackson Sun's archives.

She was accused of stealing mail from 135 victims in West and Middle Tennessee for the purpose of stealing identities and embezzling money. She later pleaded guilty to one count of mail theft and was sentenced to five years in prison and three years' probation.

At the time, the judge said Hayes had the highest criminal history score of any woman he had seen in his 20 years as a judge. The bulk of her prior convictions were for theft and fraud, but she was also convicted of escape from a Metro Nashville jail. Watson had charges stretching back to 1989, most of them in Middle and West Tennessee. She reported to a probation officer in Jackson under the name Sheila Hayes and told them she worked for a construction company.

Becker's ASC Review had an article about a three-week trial where a Detroit federal jury convicted Jose Castro-Ramirez, MD on 13 counts in connection with an $18.3 million Medicare fraud scheme.  Dr. Castro-Ramirez was convicted of one count of conspiracy to commit healthcare fraud, 11 counts of healthcare fraud and one count of conspiracy to launder the proceeds of the fraudulent scheme.

Beginning in 2003, the Detroit area physician entered into an agreement with Suresh Chand, a co-conspirator and owner of several companies based in Warren, Mich., that purportedly provided physical and occupational therapy services to Medicare beneficiaries.  In reality, Mr. Chand and his associates created false therapy files documenting physical and occupational therapy services to Medicare beneficiaries that had not occurred. The fictitious services were then billed to Medicare through fake providers controlled by Mr. Chand.

Mr. Chand and others paid kickbacks and provided other inducements to Medicare beneficiaries in exchange for their Medicare numbers and signatures showing they had received therapy services. Dr. Castro-Ramirez signed therapy prescriptions falsely indicating that he had evaluated the Medicare beneficiaries and recommended the therapy, when in fact, he had not overseen any treatment to the patients and was aware that he was participating in fraud.

Dr. Castro-Ramirez also wrote thousands of prescriptions for controlled substances including Vicodin and Xanax for patients he had never seen between 2003 and 2007, as part of Mr. Chand's recruitment of the Medicare beneficiaries.

Dr. Castro-Ramirez profited from the scheme by receiving proceeds from billings to Medicare for "home visits," many of which were never made, for beneficiaries Mr. Chand recruited. Mr. Chand also distributed proceeds directly to Dr. Castro-Ramirez through transactions intended to hide the origins and nature of the funds. Dr. Castsro-Ramirez submitted $1.4 million in claims to Medicare for the "home visits," $929,000 of which Medicare paid. Mr. Chand and his co-conspirators submitted claims to Medicare totaling $18.3 million for therapy services that were supposedly overseen by Dr. Castro-Ramirez but were never performed. Of these, Medicare paid $8.56 million.

Mr. Chand pleaded guilty in Sept. 2009 in U.S. District Court to one count of conspiracy to commit healthcare fraud and one count of conspiracy to launder money.

At a scheduled June sentencing, Dr. Castro-Ramirez faces a maximum penalty of 10 years in prison and a $250,000 fine for the healthcare fraud conspiracy and fraud counts, as well as a maximum penalty of 20 years in prison and a $250,000 fine on the money laundering conspiracy count.

Visiting Physicians Association will pay $9.5 million to settle for submitting false claims to Medicare, Medicaid and the military TRICARE medical program.  The doctors' group submitted false claims for unnecessary home visits, tests and procedures, as well as services that were never provided.   The claims were for people with Medicare, Medicaid and the military TRICARE insurance programs.   The settlement resolves four lawsuits filed by private plaintiffs under provisions of the False Claims Act, which permit private parties to file an action on the government’s behalf and share in any recovery. This settlement provides that the four whistle-blower plaintiffs will collectively receive a total of approximately $1.7 million.

Visiting Physicians Association, which has provided home health services in Michigan, Ohio, Georgia and Wisconsin, will make the payments to the U.S. government and the state of Michigan, to settle the allegations that it submitted claims for unnecessary home visits, unnecessary tests and procedures and other services it never provided.

The L.A. Times had an article discussing the recent fine imposed on a nursing home facility.   Lakewood Manor North Nursing Home has been fined $100,000 after state officials concluded that poor care led to the injury and death of an elderly resident who fell and hurt his head.

The case involved a resident who lost his balance and struck his head on a bed rail when he was being transferred from his bed to a wheelchair. State officials said the facility failed to provide adequate support for the resident as he was transferred to his wheelchair.

At 8:30 a.m., about half an hour after the blow to the head, nurses' notes documented the man had a bluish discoloration on the left side of his head. The attending physician was paged at 8:45 a.m. and 12:30 p.m., but the doctor did not return the call. His condition continued to deteriorate throughout the day; he refused lunch and dinner and complained of not feeling well.  At 8:30 p.m., he was observed as lethargic. Finally, at an unspecified time, an attending physician was reached, and the patient was transferred to a hospital at 9:30 p.m.—more than 13 hours after he had struck his head. The patient had suffered bleeding in the brain and died five days later.

Investigators said the licensed nurses should have called either an alternate physician or the medical director when the attending physician did not respond to pages, or call 911 in an emergency.

“Failure of the facility staff to immediately notify the physician and to provide the necessary care and services to Resident 1 [the patient] ... presented a substantial probability that serious harm would result, and did result to Resident 1 [the patient’s] death,” the report said.
 

A new report shows that Medicaid programs are failing to deliver adequate medical services to the low-income populations they were designed to serve including nursing home residents.  The non-profit consumer advocacy organization Public Citizen issued a report ranking Medicaid programs by how they met and surpassed federal mandates in four categories: eligibility, scope of services, quality of care and provider reimbursement.

Fifty-five million, mostly low-income Americans get their health care coverage through their state Medicaid program. The worst Medicaid programs in the country, according to Public Citizen, are those in Alabama, Colorado, Idaho, Indiana, Mississippi, Missouri, Oklahoma, South Carolina, South Dakota and Texas.

Public Citizen ranked states by the optional health care services that states provide beyond legally mandated services.
"Medicaid desperately needs nationwide uniform standards of quality of care and an effective means of monitoring and upholding those standards," said Ms. Ramirez de Arellano.

See story here

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