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

The Des Moines Register reported the investigation and charges filed against Emeritus (one of the nation's largest senior living companies) for operating an unlicensed assisted living facility and misrepresenting their licensure status to the public.  Emeritus at Silver Pines is a Cedar Rapids home licensed as a residential care facility that can provide personal assistance and supervision, but no nursing care.  Over the past 30 months, the owners of the 72-bed facility have allegedly promoted the home as an assisted living center that is authorized, equipped and staffed to provide residents with a relatively high level of medical assistance and care. The Iowa Department of Inspections and Appeals has temporarily barred the home from accepting new residents, imposed a $13,000 fine and ordered the owners to hire a new administrator.

Emeritus is the nation's largest assisted-living company, with annual revenue of $900 million. It operates 308 senior-living communities in 36 states, with a total potential capacity for 32,300 residents. The chain recently purchased an additional 140 homes from the bankrupt Sun West chain of care facilities.

Emeritus could face criminal charges for falsely claiming to be a state-licensed assisted living center.  It's a crime in Iowa for a company to falsely claim that it's a state-licensed assisted living facility, h, and the Iowa Department of Inspections and Appeals plans to refer the matter to county prosecutors for consideration of criminal charges.

Disabled Iowans - some near death and in need of constant supervision or skilled nursing care - signed contracts with the home that specifically described the facility as "licensed by the state of Iowa as an assisted-living facility." In some cases, residents were referred to Emeritus by physicians who were led to believe that the home was licensed to provide skilled nursing care.

Company records indicate the home has been charging each of the residents up to $3,800 per month in fees. In at least one instance, it allegedly charged a resident $10,000 as a nonrefundable "move-in fee."

The company's false claims should have been uncovered in March when inspectors visited the home.  Emeritus was cited for having two residents whose medical needs could be met only by an assisted living center or a nursing home. The home promised that in the future it would only admit people who were suitable for a residential care facility. In July, inspectors revisited the home in response to a complaint and saw the problem was much larger in scope than they had previously believed. For at least 30 months, the home had been holding itself out as an assisted living center. Some of the residents were being treated for cancer, kidney failure and severe dementia. Some were receiving hospice care.  In all, 17 residents were judged to be in need of care above and beyond what could be legally provided by the home.

State inspectors determined the home's new administrator, hired just a few weeks before, had no education or experience pertaining to the management of a residential care facility and didn't meet the minimum legal requirements to run such a facility.

The home's website and automated telephone system continued to promote the home as "the assisted living community of choice."

Emeritus Senior Living owns two other Iowa care facilities: Northpark Place Senior Living Community in Sioux City, a residential care facility the company purchased on Aug. 5, and Emeritus of Urbandale, a fully licensed assisted living facility that has faced numerous sanctions from the state in the past 18 months.  At one point, the Urbandale facility's on-call registered nurse was a company official who lived in Urbana, Ill., a six-hour drive away.

One employee of the Urbandale facility allegedly admitted to inspectors that she had destroyed a patient's medical records and then created new, fictional reports to conceal the fact that a dying resident's children had to administer medication to their parent on several occasions because no nurse was available in the facility.

The Urbandale home has also been cited for housing a violent individual who assaulted and sexually fondled other residents over a period of several days until police were called and he was escorted from the building.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Health Leaders Media and the blog Free Market Mojo wrote interesting articles about how Medicare policies increase hospice stays.  The Medicare hospice benefit is designed to provide visits by an interdisciplinary care team to better manage pain and other end of life issues and to provide psychosocial and spiritual support in the nursing home setting for residents and their families.

However, the length of an average Medicare-certified hospice stay in a nursing home has doubled during the last decade, researchers at Brown University have found.  Published in the August Journal of the American Geriatrics Society, their study finds that standard treatment time in nursing homes between 1999 and 2006 has increased from 46 to 93 days.   The study proves that nursing homes make more money by placing a resident on hospice because the standard daily payment rate for most Medicare hospice enrollment acts as an incentive for extended stays.

The study also found that the doubling of Medicare services in nursing homes is related to a 50% growth rate in the number of hospices—primarily for profit hospices.  Stays were longest in states with the greatest provider growth.  At the current time, a third of Medicare beneficiaries who die in nursing homes are accessing hospice services, and the study predicts that this number is expected to increase.

In addition to changing the rates of payment to reflect the proper timing of the more intense care needs, the researchers agree with a Medicare Payment Advisory Commission's recommendation that procedures for determining hospice eligibility recertification should be strengthened.

These changes would help the Medicare system avoid the possible scrutiny of nursing home residents who live beyond the physician certified six month prognosis—a Medicare requirement for hospice eligibility—and would permit patients to access the hospice care when they actually need it. 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Joanna Weiss of the Boston Globe wrote a great article on Medicare and waste. Below is excerpts of the article which is based on her experience with a relative on Medicare.  One axiom of our Medicare system: It’s hard to understand how maddening it is until something happens to your family.

Take, for example, my own elderly relative, who recently spent time in the hospital. Everyone wanted him to recover at home, but we knew that would require nursing care. And his care coordinator in the hospital had strange, bad news: If he went to a residential nursing home, Medicare would foot the bill. But if he wanted an at-home nurse, at substantially less cost, Medicare would only cover a few hours of care, a few days a week.

To anyone with a smidge of common sense, that sounds absurd. But when I relayed the story to Dr. Brent James, he wasn’t surprised. As chief quality officer at Intermountain Healthcare, a network of hospitals and providers in Utah, he’s an expert in Medicare’s one-size-fits-all solutions and perverse incentives. More than a decade ago, his hospitals put a reform in place, involving the timing of antibiotics, that helped patients recover more quickly and completely. But the hospitals were losing millions of dollars, and the billing records solved the mystery. If a patient got pneumonia and went on a ventilator, the reimbursement from Medicare was $800 more than the treatment itself. If that same patient didn’t get pneumonia, the billing codes changed, and the payment for his briefer, simpler hospital stay was $800 less than the cost.

James has implemented many solutions at Intermountain. Among them are “global payments,’’ which opponents have managed to demonize as rationing of care. As James explained it to me, it’s a far-less-nefarious way to create the the right incentives in a system that now often has the wrong ones.

In the case of my elderly relative, Medicare would give his hospital a set amount of money to coordinate and spend. Any money left over would be profit. If the payment fell short of the cost of his care, the hospital would eat the loss.

In theory, that could give doctors and nurses a reason to provide him with less care. Careful monitoring of quality would have to go hand in hand with global payments. But this change could also encourage steps known to reduce the length and cost of illnesses. Washing hands more often to reduce the spread of infection. Coordinating better among hospital divisions. Offering better access to the home-based nursing care that would cost a lot less.

“Over 50 percent of expenditures on a patient on health care are technically waste,’’ James told me. But “one person’s waste is another person’s income is a major political contribution.’’

According to some health care and economics experts — including Roger Feldman and Bryan Dowd at the University of Minnesota and Bob Coulam at Simmons College, who wrote a recent paper on the subject — competitive pricing would shave 8 percent off the annual Medicare budget. That amounts to $50 billion to $60 billion every year. And yet, every time that reform has been proposed, providers have revolted, and Congress has blocked it in a very bipartisan way.

Now we have a looming crisis, a foreseeable future when the Medicare Part A trust fund will go bankrupt, or when Medicare costs will start to overwhelm the federal budget. There will come a point when ignoring the problem won’t be feasible anymore. Maybe it will happen too late to help some of my own relatives. But when it does happen, there’s some small comfort in knowing that solutions are out there — just waiting for action, a little bit of courage, and a will to change.
 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Here is another article (from The Orange county Register) about how nursing homes used increased funding to pad their bottom line instead of increasing staffing.  Nursing homes were supposed to use the increased funding to hire more staff and increase the hours per patient.  One again, greed and profits take precedence over the care provided to nursing home residents.

Covenant Care's facilities are among hundreds of California skilled-care centers that received $880 million in additional compensation from the state since 2004 to increase staffing and wages at homes that serve Medi-Cal patients. An analysis by the non-profit newsroom California Watch found that 232 of those homes statewide slashed staff and let nursing ratios fall below the state minimum despite receiving the additional funds.

St. Edna and 12 other homes run by the Aliso Viejo-based Coventant chain were among those that stood out: They accepted $15 million in additional compensation from the state but still cut caregivers, California Watch found. Meanwhile, Covenant Care rewarded facility leaders with bonuses based, in part, on new profits.

The company's marketing promises the "highest quality of care" and a staff that treats consumers as "family." But St. Edna's overall service is rated "much below average" on the California Department of Public Health website – the lowest rating given. Staffing at the facility fell 5 percent between 2004 and 2008, settling below the state minimum of 3.2 hours per patient.

St. Edna received 119 citations and warnings over the past three years, compared with a state average of 54.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Buffalo News had an article about nursing home employees embezzling money that should have gone to the resident's care.   Mary Blenker is the second employee of the Absolut nursing and rehabilitation complex in Orchard Park to plead guilty to corporate embezzlement.

Blenker admitted to stealing $13,402 from the disbursement funds she managed for the company’s adult living community and its nursing home from January 2007 until 13 months ago.  Blenker pleaded guilty to felony grand larceny and misdemeanor attempted grand larceny for the thefts before a grand jury reviewed her case.

Blenker, a former administrative assistant for financial affairs at the nursing home complex, was forced to sign confessions of judgment and must make complete restitution.

Rhonda Skiver, Absolut’s former chief financial officer, faces sentencing on her Feb. 19 guilty plea to embezzling more than $163,000 between December 2005 and April 2009.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Sacramento Bee had two articles here and here about the jury's verdict against Colonial Healthcare and its parent company, Horizon West of Rocklin.  The jury found that the nursing home committed elder abuse in the death of a woman in 2005.  After deliberating fewer than two days, the jurors unanimously agreed that Defendants were responsible for the death of Frances Tanner.

They awarded $1.1 million in damages for Tanner's pain and suffering and for her daughter Elizabeth Pao's loss of companionship. They also decided that the home's conduct was "malicious, oppressive or fraudulent," therefore punitive damages may be awarded also.  The jury will hear further testimony about the corporation's finances before deciding on punitive damages.

Tanner was 79 years old, spirited and mobile but suffering from mild dementia, when she moved into the home in March 2005. Seven months later, after a preventable fall caused by neglect that resulted in a broken hip, she was dead from an infected bedsore.  Jurors heard evidence of chronic understaffing, poor medical documentation and corporate greed. One former Colonial staffer said he would not place a relative at the home.  Colonial and Horizon put profits before good patient care.

Colonial, which recently changed its name to Hilltop Manor, has a history of problems with state regulators. The Tanner case was the fourth in recent years in which the home was cited in the death of an elderly patient.

"We have a corporate culture here that is callously indifferent to human life," Sacramento attorney Ed Dudensing said in closing arguments this week.  "They value money but not patient care."

Colonial "recklessly failed Frances Tanner in every way conceivable," Dudensing said, including allowing her to endure a fractured hip, keeping poor notes on her care and missing the skin condition that killed her.

One advocate, Carole Herman of Foundation Aiding the Elderly, said lack of proper staffing may be the most critical issue facing nursing home patients and their families.

Here and here are two article reporting the $28 million puntive award verdict.   "The jurors obviously felt that this is what they needed to do to send the message, to attempt to deter future bad conduct," Dudensing said. 

They decided on punitive damages after hearing evidence about the corporation's finances.  Horizon West is worth about $200 million. He suggested $10 million would be an appropriate punitive award for the chronic understaffing and inadequate care that he said led to Tanner's death.

Read more: http://www.sacbee.com/2010/05/14/2749834/nursing-home-ordered-to-pay-28.html#ixzz0nubuVtAc
 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Another tale of greed and callous disregard to nursing home residents in California Watch.  The article explains how nursing homes in California were given an additional $880 million in government funding to increase staffing, boost wages, and improve care, but the vast majority used the extra taxpayer money to pad their bottom lines and give bonuses to corporate managers.

Most either cut staff, paid lower wages or let caregiver levels slip below a state-mandated staffing minimum. Many nursing homes appeared to use the cash infusion to help bolster their bottom lines, according to a California Watch analysis of state nursing home data.   The failure to improve staffing led to increased violations and neglect.

“Money talks, we know that,” said Molly Davies, director of the nonprofit Wise & Healthy Aging, the Los Angeles elder care ombudsman program. “If you’re going to give extra money, there needs to be an understanding of what the state is going to get in return and what those clients are going to get in return. I don’t think that was made clear.”

In 2008, dozens of homes operated beneath the decade-old staffing standard – which is set at a minimum of  three hours and 12 minutes of caregiver attention a day for every nursing home patient. In the homes where staffing lagged, patients suffered.  The state, however, has not issued staffing-related fines to any of the homes that failed throughout 2008 to reach the minimum staffing level, records show.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Fresno Bee reported a class action lawsuit regarding short staffing at Valley Nursing Home.  The lawsuit claims the obvious--that a group of for-profit nursing homes have put elderly residents at risk and skirted state law by skimping on staff to make more money.  Nursing home residents say staffing problems have plagued homes operated by Skilled Healthcare Group Inc., the 10th-largest nursing home chain in the country.  More than 32,000 nursing home residents are represented by the class action.  They hope to improve care.

Industry and advocates for nursing-home reform are watching the case closely. It's not the first class-action case nursing homes have faced for staffing problems, but the size of the case means it could have a far-ranging effect on how nursing homes are staffed.

Millions of dollars could be at stake. In addition to seeking punitive damages, the plaintiffs are suing for statutory damages for each day the nursing homes are found out of compliance with staffing laws. The plaintiffs contend the California homes were under-staffed thousands of days over the six-year period -- 2003 to 2009 -- covered by the lawsuit. Penalties can be up to $500 per resident for each day the law was violated.

Lawyers for the nursing-home residents say they hope not only to win restitution for residents, but also to spur reforms in the industry. "We want to change the corporate culture of the for-profit nursing operators to have them start paying more attention to the nursing of the residents and less attention to shareholders," said Michael Crowley, lead trial counsel for the plaintiffs.

Skilled Healthcare Group of Foothill Ranch was the nation's 10th-largest nursing home chain in 2009, based on the number of nursing beds, according to the trade journal Provider Magazine.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Washington Post had an article regarding the practice of "upcoding" in nursing homes, putting residents in ultra-high billing categories intended to be used for only 5% of residents needing highly specialized care and rehabilitation. To increase reimbursements and therefore profits, the nursing home represents that the residents need more care than they actually do. 

Since the system was instituted over 10 years ago, the numbers of residents in the ultra-high categories has quadrupled and amount of waste and abuse could reach billions of dollars a year. This billing program is specifically targeted in the new health care legislation changing 2 rules that experts said have been exploited by nursing homes to inflate bills.

North American Health Care (NAHC) is one of the worst placing 64% of its residents in the highest category; the national average is 9%.  HCR ManorCare is another chain that abuses the system.

Homes that provide the highest level of care are known as skilled nursing facilities and have become a big business. There are about 15,000 nationwide, and they rely heavily on Medicare to turn a profit. Last year, Medicare spent more than $25 billion on them.

"Upcoding, billing for services not rendered, and billing for worthless services have been significant problems for years, costing taxpayers many millions, if not billions, of dollars," said Marie-Therese Connolly, who headed the Justice Department's Elder Justice and Nursing Home Initiative from 1999 to 2007.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Another lawsuit involving nursing home owners and operators Murray Forman, Leonard Grunstein, and Rubin Schron.  Forman and Grunstein are accusing Schron of  treating their company as "his personal piggy bank" and looted it for more than $100 million.   Rubin Schron first fattened his piggy bank in 2006, with $40 million that he claimed was repayment of a capital contribution from CAM-Elm Co., his family-owned business that's majority owner of plaintiff SMV Property Holdings.

Schron took $66 million more in 2008 and 2009 to recoup money he lost in personal investments, including rate swaps with Citibank, shareholders say in New York County Court.  Schron's eight children were majority owners of CAM-Elm, giving them the right to remove their father from his position, but since they did not, the plaintiffs say, they are suing them too.

"Schron is not content with the substantial economic returns that he, his family, and his companies have "legitimately" earned. Instead, Schron has resorted to theft, improper accounting manipulation, and more, against those who trusted him and relied on him," the complaint states.

Schron has also accused Leonard Grunstein and Murray Forman of "stealing from the company," so they added a defamation charge to the claims of misappropriation.   Of course, truth is the ultimate defense to defamation.

The plaintiffs seek an accounting and $105 million in damages and want Schron booted from his position and new managers appointed.  See full Complaint here.

• Email This
• Print
• Comments
• Trackbacks
• Share Link