Insurance companies override doctor's orders

The Toldeo Blade has a sad article about the effects of delays and denials caused by for profit insurance companies making health care decisions for residents instead of health care professionals.  This should be criminal the way the health care industry denied this man's chances of survival. 

The article discusses various specific cases.   Randy Steele, 64, of Oak Harbor was transferred back and forth between health care facilities as physicians attempted to stay ahead of the hepatitis C virus that was slowly threatening his liver and kidneys.

He was finally referred to specialists at Cleveland Clinic to offer a second opinion on a potentially life-saving kidney-liver transplant. Cleveland Clinic fit Mr. Steele onto its schedule. But instead, his appointment was canceled and he waited weeks to learn if his insurer would pay for this life saving measure.

Mr. Steele, like many patients across the country, was the victim of a complex health-care bureaucracy and an insurance industry that repeatedly denies doctors’ orders — leaving patients bewildered and suffering.

Bill Hodnik, 41, endured the same shortcomings.He suffered months of avoidable pain while his insurer delayed and denied coverage for a necessary surgery ordered by his physician. Mr. Hodnik’s physician told him the optimal solution to his problems would be cutting-edge artificial disc replacement surgery.

The surgery was scheduled, but he never underwent the procedure. After months of repeated delays and denials from his insurer, and with his disability insurance running out, Mr. Hodnik needed to return to work, and so — against doctor’s orders — he settled on fusion surgery.

Doctors nationwide believe there is an emerging crisis in providing health care to their patients because insurers routinely challenge their orders.

Doctors said patients usually receive some of the therapy, testing, medication, or procedures needed and prescribed for them. But too often, physicians said, there’s a lapse in time between the office visit and when the care or test is delivered because of interference by insurers.

 

Nursing home dumping

The Wall St. Journal had an article recently that made me think about the future of helath care when the baby boomers enter the nursing home industry.  Will there be a revolution in health care?  Will for profit chains dictate how the old and frail among us will conclude their lives? 

A nursing home in California wants to evict Jasmine Nguyen, a 32-year-old dependent on a ventilator to breathe and the facility's staff for her daily needs, and a dozen other residents in similar situations replacing them with short-term residents that bring more profit.

Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if -- like Ms. Nguyen and the other Lodi residents -- they depend on Medicaid to pay their bills, the officials and advocates say.

Assisted-living facilities have sprung up as alternatives for those who don't require nursing-home care but need assistance with things like taking medications or bathing and dressing. Each state regulates the industry differently, so eviction policies vary. But many states simply require facilities to give four- to six-weeks' notice, with no appeal guaranteed.

In Florida, for example, the state's 2,400 assisted-living facilities must give residents 45 days' notice before evicting them, but don't need to provide a reason or appeal process. 

No national figures on assisted-living evictions exist, but discharge-related complaints recorded by the federal Administration on Aging more than doubled in the decade before 2006, rising 177% -- nearly twice the growth for complaints overall.  Some attorneys are turning to federal fair-housing rules and the Americans with Disabilities Act to help assisted-living residents stay in their homes. They argue that those laws require all landlords, including assisted-living companies, to make reasonable accommodations for disabled residents, and prohibit them from evicting residents because their condition worsens.

And evictions may be even more widespread, since some eviction attempts are resolved without formal complaints. Residents may not know they can appeal or may be too ill to do so or fear retribution.  Federal law -- enforced by the states -- says residents can be discharged involuntarily for just six reasons: if they are well enough to go home; need care only available elsewhere; endanger the health of others; endanger the safety of others; fail to pay their bills; or if a facility closes its doors. Even so, nursing homes must give residents at least 30 days' notice, explain their appeal rights, and put together a plan to make sure the move doesn't harm them.

Even an orderly eviction can carry grave risks for the old and ill. Studies suggest "transfer trauma," or relocation-stress syndrome, can spur depression and weight loss and increase the risk of falls.

For example, the nursing home trying to evict Jasmine Nguyen, Lodi Memorial Hospital, told her and a dozen others that they would have to move by June 30 because the nonprofit organization was closing the facility -- for renovations.  All 13 residents were "sub-acute" patients, most of them dependent on ventilators or feeding tubes, or with other conditions requiring significant extra care.

Lodi Memorial told the state it planned to replace them with patients recently discharged from its hospital -- who typically require shorter-term care covered at a higher daily rate by private insurance or by Medicare. (Medicare pays for up to 100 days in a nursing home following a hospital stay of at least three days.)

In April, after Lodi Memorial sought state approval, administrators were told that they knew when accepting the sub-acute residents that they would need extensive care, probably for many years, and it couldn't simply stop. Moreover, the state said in a letter, "your facility is not ceasing to operate as you are not surrendering your license."

The nearest nursing home certified to care for patients like Ms. Nguyen is about two hours away with traffic, says Jasmine's 23-year-old sister, Mary. Their mother, Kim Nguyen, who runs the family nail salon in nearby Stockton, visits Jasmine twice a day.

 

Future Costs of Long Term Care

Prudential Study Sheds Light on the Increasing Costs of Long-Term Care.  Prudential website has a great tool to determine the cost of long term care in each state. 

According to the U.S. Census Bureau, by 2030 the number of Americans aged 65 and older will more than double to 71 million, comprising approximately 20 percent of the U.S. population. With an aging population boom, Prudential issued 2008 Long-Term  Care Cost of Care research report.  The study found an increase in the average cost of long-term care ranging from 5% to 13%, varying by type of service, in the past two years alone.

"Many Americans mistakenly believe that Medicare or private health insurance will pay for their long-term care needs. The reality is long-term care risk is substantial, and under current Medicare and Medicaid policy, much of it is the uninsured private responsibility of individuals who pay for care and of families who care for their relatives," said Andy Mako, Senior Vice President, Long-Term Care Insurance, Prudential.

Prudential's Cost of Care study sheds light on the State-specific average costs associated with nursing homes, assisted living facilities, and home health care services.

The study related significant issues:

-- Average costs for long-term care services increased over the past two years and are expected to continue to rise. The average daily cost for an assisted-living facility is now more than $100, or $3,241 per month. What's more, the average daily cost of a private room in a nursing home is now $217, or $79,205 annually.

-- Home health care experienced the smallest rate increase, rising just 5 percent over the past two years. The average hourly rate for a home health aide/certified nursing assistant increased by $1 in the past two years, to $21.

-- Costs for long-term care services continue to vary significantly by location, with Alaska, New York City, and Stamford, CT consistently being the most expensive areas for nursing home and assisted living facilities, and Oklahoma City, St. Louis, and South Dakota being the least expensive.

In addition to the report being available to consumers on www.prudential.com, Prudential is also launching an updated interactive consumer cost of care mapping tool on its website at www.prudential.com/insurance/longtermcare, designed to provide more in-depth State-specific cost detail - and in some cases City-specific - aimed at arming consumers with essential facts to help them make better financial decisions. "While consumers understand the importance of planning for their financial future, they continue to have misperceptions about the costs of long-term care services and the benefits of long-term care insurance. Our resources can help them dispel these myths and put them on the right path to securing their retirement," added Mako.

 

Sunrise Senior Living promises better care....again.

The Dealmakers Forum has an article about Sunrise charting a new course and discussion of how much money they are allegedly losing. 

Sunrise Senior Living was founded 27 years ago by Paul and Terry Klaassen when they opened a small nursing home in Virginia they purchased for just $325,000.   Now, 27 years later, the company manages more than 440 nursing homes in four countries, has revenues under management of more than $2.4 billion, boasts an average same-community occupancy rate that has been at 90% or better for four consecutive quarters and is perhaps the only company in the industry with a national brand name known to the consumer.

Mr. Klaassen will be relinquishing his chief executive officer duties and will become the non-executive chairman of the board. Mark Ordan, who was brought in earlier this year as the chief administrative and investment officer, will take over as CEO. And with this change, an era in our industry will come to a close

The company finally filed its 2007 10-K on July 31—the promised date—and the accounting mess that started two years ago is close to coming to an end.  The 2007 financial statements stated that total operating revenues last year were basically flat with 2006, and the importance of "buyout fees" to the company’s overall financial performance in both 2005 and 2006. In addition, hospice and ancillary service revenues inceased by 64%, but the associated expenses increased by 80%, causing this business category to go from a small profit to an $8.8 million operating loss.

For 2007, Sunrise posted a net loss of $70.3 million, which was after $214.0 million of gains from real estate sales and the company’s share of earnings in unconsolidated communities. These gains and earnings more than offset the combined $166.5 million in unusual cost items such as loss on financial guarantees ($22.2 million), impairment of goodwill and intangible assets ($56.7 million), write-off of abandoned development projects ($28.4 million), impairment of owned communities ($7.6 million) and the accounting and legal cost of the accounting restatement ($51.7 million).

This means that operating EBITDA was a negative $73.4 million, compared with a positive $110.2 million in 2006. That is a downward swing of $183.6 million, caused mostly by the disappearance of the previously mentioned "buyout fees," which were $134.7 million in 2006 and next to nothing in 2007, and represent, we assume, the fees paid by Five Star Quality Care to Sunrise to buy out Sunrise’s management agreements for properties leased by FVE but operated by SRZ.

The other large item was G&A expense, which increased by a whopping 42.5% year-over-year to $187.3 million but should not include all those costs associated with the accounting restatement. If you do the math, this means that without those buyout fees in 2006, operating EBITDA would have been negative in that year as well, although not as large as 2007. We still have trouble understanding how the management model that Sunrise has adopted can work in this industry if a company can’t make money managing more than 440 properties around the world.

The end result is that the entire increase in cash during 2007 came from a net $56.7 million increase in borrowed funds. In addition, the company had a negative working capital of $116.3 million at the end of 2007 due to $222.5 million of short-term debt and the current portion of long-term debt. Although we usually don’t get worked up about working capital for Sunrise, when the bank line-of-credit is reduced (which it was in July) because of breeches in loan covenants, it does make one pay closer attention to some of the details.

So what has happened over the past several years to this giant in the industry? In an effort to make more money and exclude from themselves from liability or accountability, Sunrise entered into tricky financial loans and buyouts to prevent any judgments for neglect to be collected.

In looking back over the past five years or so, it seems that the biggest problem was that Sunrise got a little ahead of itself, believing that it was so good that it could take risks that others might not take, with some competitors accusing the company of a certain degree of arrogance.  In addition,  Sunrise decided to get quite aggressive with accounting interpretations several years ago, and it came back to bite them in a big way. 

But enough of the past and on to the future. As management transitions from Mr. Klaassen to Mr. Ordan, there will be increased attention on cost control, and after the unprecedented increase in overhead expense last year, the company has announced a program to cut between $15.0 million and $20.0 million on an annualized basis beginning in 2009, which will include some "voluntary" employee reductions.

Second, while Mr. Ordan are concentrating on cutting overhead costs, the other complaint we hear is that management is not paying attention to operations at the local level. Quality of care is crucial, especially for the industry leader, and you don’t want what happened in Pennsylvania last year to happen again, anywhere. With less focus on development over the next 12 months, there should be renewed focus on operations. While it is great that Sunrise has grown to 440 properties under management, that itself may be part of the problem. This industry has some great leaders, but when you scratch beneath that, all we hear is that there is a huge management void, and we hear this from operators themselves.


 

Corporations take assets from bankrupt nursing homes

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

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

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

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

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

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

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

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



Tennessee law will protect for nursing homes that abuse and neglect residents

Tennessee nursing homes are seeking unprecedented legal protection from residents who are abused or neglected.   Politicians influenced by nursing home lobbyist campaign donations introduced a bill that would severely restrict the rights of nursing home victims to seek justice no matter how bad the injury they suffer and no matter how bad the conduct of the home.

NHC, which reported more than $500 million in annual gross profits in 2006 and whose CEO Robert G. Adams makes more than $1.3 million a year, pushed for the legislation.   The legislation would ensure that:

Residents would have little to no recourse against nursing homes no matter how bad the conduct of a home.

Nursing homes can demand that residents sign arbitration agreements waiving their constitutional right to a jury trial in order to get medical care, making nursing home residents the least protected class in the state.

“This proposed legislation is a slap in the face to some of Tennessee’s most vulnerable citizens – the residents of nursing homes and their families,” said Karla C. Hewitt, president of Tennessee Citizen Action, a grassroots consumer protection organization.  “Nursing home residents are suffering. Inspectors have found residents with maggots in their wounds and broken bones that aren’t treated,” Hewitt continued. “And now this billion dollar industry wants to take away the rights of individual residents to sue? This shows how low the nursing homes will go to protect their shareholders' profits.”

Though the multi-billion dollar nursing home industry complains of an epidemic of frivolous litigation, in fact only four verdicts were awarded against Tennessee nursing homes from 2005-2007.   During that same period, nursing home admission suspensions tripled. In 2007, 22 nursing homes had their admissions suspended for putting their residents in “immediate jeopardy.” According to records at the Tennessee Department of Health, the 152 immediate jeopardy violations in those homes include reports of patients suffering the following:

Risk of injury or death by fire
Maggots in wound
Broken bones unattended for days
Drastic weight loss due to improper nutrition/oversight
Impacted bowels caused by inattention/oversight
Extreme pain with no relief
Fear of staff

In addition to these violations, a worker at a home in Madison was arrested in May 2007 for raping a 70-year-old resident.

The State of Tennessee allocates 99% of funding from the Centers for Medicare & Medicaid Services – more than $1 billion a year – to nursing homes and only 1% to home and community-based care.  


About Tennessee Citizen Action (TNCA)

TNCA is Tennessee’s consumer watchdog organization working on behalf of a number of consumer protection issues, including patients’ rights; nursing home reform; quality health care; increased home- and community-based options with more consumer control; title lending; aftermath of sub-prime lending crisis; workplace health and safety; and voter education, registration, GOTV, problems with electronic voting and lack of a paper trail. TNCA is a grassroots citizen group based in Nashville seeking to build a unified movement for reform in Tennessee. TNCA works to create long-term political change by building diverse coalitions around our major issues. The organization actively works in coalition with a range of health care, environmental, government reform, and labor organizations. For more information, visit: http://www.tnca.org.


Contacts
Tennessee Citizen Action
Shelby White, 615-327-7999


Family files wrongful death suit against nursing home

Jay Cameron whose mother died in a California nursing home filed a lawsuit against the facility saying it caused his mother’s death by reducing staff to save money. 

Cameron alleges the home committed elder abuse, fraud, wrongful death, negligence and violated patient rights. He is asking for an undetermined amount of money and reimbursement for attorneys’ fees. 

Cameron’s mother, Margaret Williams, was a resident at Mission View before being transferred to French Hospital Medical Center where she died.  Williams fell three times at the facility, suffered a hip fracture and developed pneumoniacausing her death.

Compass Health and administrators at Mission View are trying to increase profits by reducing staff and employing people who were not properly trained or qualified, leading to Williams’ death.

Attorneys for Cameron, Greg Coates and Michael Thamer, argue that the nursing facility took short cuts in care that resulted in unsanitary and hazardous living conditions and left residents unsuper vised. They also said there was an increase in accidents and injuries suffered by residents and nursing staff and other signs of inadequate care.

State records for 2006-07 show the state Department of Public Health issued three citations against the home in 2006 for patient care and fined the facility $2,800, spokeswoman Lea Brooks said.   In April 2007, during a recertification survey, state investigators found deficiencies at the home, Brooks said.

Review of nursing home fines in Iowa

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.

Iowa's nursing home owners can pay only $10,000 for serious health and safety violations, abuse, and negelct causing death.  The amount of fines have not changed in 22 years.

"I tell you, somebody's been doing a great job of lobbying to keep the fines at that level," said John Tapscott, an advocate for seniors who spent six years in the Iowa Legislature. "The reason the fines haven't changed is all the political influence these homes have." 

Nursing home corporations are aggressively lobbying state legislators. They host campaign fundraising events for key lawmakers, and are collecting information on the registered nurses who work as state nursing home inspectors.

The battle could come to a head during this year's legislative session, with lawmakers being asked to side either with state inspectors or with an industry that has a team of lobbyists and a well-funded political action committee.

The debate over fines first surfaced 14 months ago when USA Healthcare nursing home in Urbandale was fined $400 after being accused of failing to protect residents from numerous instances of assault and sexual abuse. According to state records, elderly residents and workers at the care center were choked, kicked, punched, sexually assaulted and threatened by at least two residents who suffered from dementia. There were at least 18 attacks - some by a man wielding a coat hanger - that were documented by the home. One of the attackers broke the clavicle of a fellow resident. 

A private foundation that surveys Iowa nursing homes about the inspection process gives the state inspectors high marks for professionalism and courtesy.

Iowa's fines are lower than those imposed by other states in the Midwest. The Government Accountability Office reported earlier this year that fines are so small nationally that some nursing homes view them as part of the "cost of doing business."

It's now cheaper for an Iowa nursing home to pay a Class 1 fine every year than it would be to hire just one additional nurse aide.

The finances of Iowa's for-profit nursing homes are not subject to public-disclosure laws. But the state's nonprofit care centers - which pay no income tax - must disclose some of those details. The latest available reports show that some of these nursing homes and their owners are doing well financially.

For example, Care Initiatives of West Des Moines, which owns 47 Iowa care centers, posted $140 million in revenue during 2006. Although that was $13 million less than the charity spent, Chief Executive Hulon Walker collected $2.1 million in salary, benefits and deferred compensation. The chief financial officer was paid $1.5 million, and members of the board of directors were paid up to $412 an hour.

The company, which is considered a public charity, has its own for-profit insurance company in the Turks and Caicos Islands, an off-shore tax haven. At the end of 2006, that insurance company, which provides coverage exclusively for Care Initiatives, had almost $1.4 million in cash on hand.

The Evangelical Lutheran Good Samaritan Society, a South Dakota charity that owns 230 nursing homes, including 21 in Iowa, collected $851 million in revenue in 2006, which was $30 million more than was spent operating the facilities. The charity paid its chief executive $437,784 and spent $87,000 on lobbying.

The organization, which has $1.2 billion in assets, also has its own for-profit insurance company, based in the Cayman Islands, another off-shore tax haven. At year's end, that insurance company, which provides coverage exclusively for Evangelical Lutheran Good Samaritan Society, had $4.8 million in cash on hand.

A spokesman for the "charity" said the insurance company is in the Cayman Islands because a "consultant" determined that was the "best fit" for the corporation.

Reforms proposed by Ombudsman's office

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.

Studies continue regarding quality of care in nursing homes

Studies show a significant decline in quality of nursing home care for blacks compared to whites.
Elderly black Americans in nursing homes get worse care than that enjoyed by their white counterparts.  "If you're black, you're much more likely to get your care in a nursing home that's not so good, relative to nursing homes that are serving predominantly white patients," Dr Vincent Mor, head of the department of community health at Rhode Island-based Brown University's school of medicine, told AFP on Tuesday.

Mor was a lead author of the study which looked at "racial segregation in US nursing homes and its relationship to racial disparities in the quality of care."  The study cited race data from nursing homes found US nursing homes remain relatively segregated by race.

"Blacks are much more likely than whites to be located in nursing homes that have serious deficiencies, lower staffing ratios, and greater financial vulnerability," the study showed.

Another study led by Brown University researchers and due to be published in June in the Health Services Research medical journal, looked at the rate of hospitalization of nursing home residents.
That study showed that 24.1 percent of black nursing home residents required hospitalization  compared with 18.5 percent white residents.   It found that nursing homes "with high concentrations of blacks had 20 percent higher odds ... of hospitalization than residents in nursing homes with no blacks", and linked the quality of care to the reimbursement policies of Medicaid, the US program for those unable to pay for healthcare.

The rate of hospitalization was an indicator of performance, as were "a whole variety of different measures of quality in terms of regulatory compliance, staffing levels, and so on," Mor explained.

"Both studies clearly suggest that nursing homes which have a predominance or much higher proportion of African-American residents perform more poorly," Mor said.

Putting profits over care

A Rockport, Arkansas nursing home chose to evict an elderly resident who was chronically ill. The home dropped her off at a motel in Aransas Pass and never notified the family. 

The home claims it wasn't getting paid for her to stay there.  Ladewig suffers from chronic bronchitis and a muscle disease. Ladewig said she was brought to this motel room after getting evicted. Her family were never told about the move.

When nursing home personnel dropped her off, the family said they left her with food for the weekend and these two portable oxygen tanks that would last about eight hours.

"I would have run out of oxygen and died," said Ladewig. "That's what would have happened to me if she wouldn't have come out looking for me. That's what would have happened."

"There is no phone in this facility, even if in the middle of night she went in respiratory failure or a situation where she couldn't get up, she has no way to contact anybody, whatsoever," Biggs said.

The family said the nursing home was paid through early December.

Barack Obama's statement about NY Times article

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."

CEO's exorbitant salaries hinder proper staffing

I was sent this great editorial regarding how much staff could be hired if CEOs were compensated reasonably instead of exorbitantly like Manor Care's CEO Paul Ormond.

SNF CEO'S WINDFALL COULD HAVE PROVIDED MORE STAFF AND SERVICES

To the Editor:

Reports that Manor Care’s CEO Paul Ormond would personally realize between $118 and $186 million when his company, the largest nursing home chain in the United States, is acquired later this year by a private equity group got us thinking about staffing in nursing homes. Knowing that the federal government has reported that more than 90% of nursing homes do not have enough staff to take care of their residents, we wondered how many nurses and nurse aides could be hired for a year at Manor Care’s nursing facilities with that same money.

Using federal wage estimates for nursing home workers, we calculated that Manor Care’s 278 nursing homes could hire an additional 5346 certified nurse aides or an additional 2198 registered nurses if $118,000,000 were spent on staff (19.2 aides or 7.9 RNs at each Manor Care nursing home). If Mr. Ormond’s $186,000,000 windfall were spent on staff, Manor Care could hire an additional 8427 certified nurse aides or an additional 3464 RNs (30.3 CNAs or 12.5 RNs at each Manor Care nursing home).

Like all nursing home chains, most of Manor Care’s revenues come from public programs, Medicare and Medicaid. How should our public health care dollars be spent? One man’s windfall or certified nurse assistants and registered nurses in nursing homes?


Sincerely,

Toby S. Edelman
Center for Medicare Advocacy
California Advocates for Nursing Home Reform
The John A. Hartford Institute for Geriatric Nursing
National Conference of Geriatric Nurse Practitioners

Documentation supporting statements made in the letter-to-the-editor:

Two weeks ago, Manor Care, the largest nursing home chain in the United States, announced that it had agreed to be purchased by the Carlyle Group. Early reports indicate that Manor Care’s CEO Paul Ormond will personally realize between $118 and $186 million when he exercises his stock options at the time of the sale.[1] The Center for Medicare Advocacy wondered how many nurses and nurse aides could be hired for a year at Manor Care’s nursing facilities with that money.

Referring to the Bureau of Labor Statistics’ wage estimates for nursing home workers, (the average nursing home nurse aide earned $22,070 and the average registered nurse, $53,690 in May 2006)[2] and to the 278 facilities operated by Manor Care as of December 1, 2006,[3] the Center did some calculations. Here are the results:

Documentation about staffing: The nurse staffing study submitted to Congress by the Centers for Medicare & Medicaid Services in 2001 documented that more than 91% of facilities fail to have sufficient staff to prevent avoidable harm and that 97% of facilities do not have sufficient staff to meet the comprehensive requirements of the Reform Law. CMS, Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report, pages 1-6, 1-7 (Dec. 2001), http://www.cms.hhs.gov/CertificationandComplianc/12_NHs.asp (scroll down to Phase II report).

Solutions: In testimony before the Senate Aging Committee on May 2, 2007 on the 20th anniversary of the federal Nursing Home Reform Law, Professor Charlene Harrington of the University of California, San Francisco, discussed, as one of her key points, the issue of financial accountability for public funds. She described the ability of nursing facilities, under current law, to spend their Medicare reimbursement, once they get it, as they choose, not necessarily as Congress intended. Professor Harrington’s solution is prohibiting nursing facilities from shifting costs across cost centers. Her testimony is at http://aging.senate.gov/events/hr172ch.pdf, pages 9-11.

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[1] Homer Brickey, “Manor Care sale would enrich execs; Toledo firm’s officials may receive more than $200 million for stock,” The Toledo Blade (July 6, 2007), http://toledoblade.com/apps/pbcs.dll/article?AID=/20070706/BUSINESS03/707060449/-1/BUSINESS.

[2] Bureau of Labor Statistics, Department of Labor, 2006 National Industry-Specific Occupational and Employment Wage Estimates, NAIC 623100, Nursing Care Facilities, http://www.bls.gov/oes/current/naics4_623100.htm#b00-0000.

[3] Meg LaPorte, “Top 50 Nursing Home Chains; Manor Care Soars Above The Pack By 18,000 Beds,” Provider 37 (June 2007), http://www.providermagazine.com/pdf/2007/survey_top50_2007.pdf.

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