Fox40 had an article about for-profit nursing home chains in California that illegally prioritizes some patients over others based on how much of a payout insurance will pay the individual nursing home for each.  As soon as a resident goes from Medicare (where reimbursements are high) to Medicaid (where the nursing home gets a flat fee), the chain tries to get rid of them.  These chains discharge residents without proper notice or a legal reason.  It’s called patient dumping and it’s illegal.  Under California law, nursing homes need to notify patients 30 days before they’re let go.

“What’s happened is the money’s gotten the best of the providers,” Tony Chicotel, a spokesman with the California Advocates for Nursing Home Reform,  said. He urges consumers to follow the money. “Medicare pays a significantly higher rate per day for nursing home care than [MediCal] or even private pay dollars do,” he said.  According to Chicotel, the problem is Medicare only provides a few months’ worth of nursing home care to patients. When that runs out, he says some nursing homes rush to fill her bed with someone else on Medicare.  “The more you occupy your beds with Medicare residents, the more money you’re going to make. Sometimes three or four times as much.”

He’s working on a class action lawsuit filed against SavaSeniorCare, a national for-profit billion dollar chain.  SavaSeniorCare has over 200 facilities nationwide including 4 in South Carolina.  SavaSeniorCare is also part of a False Claims Act case in Tennessee.  See Hayward doc 59.

“It’s a very widespread problem. It involves dozens of nursing home chains in California, hundreds of individual nursing homes. It’s a problem that’s affected northern, central, southern California. We hear about it everywhere,” Chicotel said.

A representative from Mission Carmichael, a care facility owned and operated by Sava, did respond to the lawsuit, saying only that they’re “aware of the case” and “cannot comment about the specifics”

 

6ABC reported on the recent audit by the Federal Government which found an alarming number of nursing homes failing to report suspected abuse, including sexual abuse.  Action News Investigative Reporter Chad Pradelli has been investigating the nursing home industry in Pennsylvania for the past year.  Pradelli looked at every state inspection report in the 5 county region for 2016 and 2017.

He found dozens of cases where nursing homes failed to properly investigate and report neglect, abuse or possible abuse both physical and sexual.  The investigation found state inspectors cited nearly half of all nursing homes in the 5 county region for either failing to investigate and/or properly report possible abuse and neglect in 2016 and 2017. 85 facilities in all were cited.

Attorney Sam Brooks of Community Legal Services of Philadelphia said, “It’s not in the nursing homes interest to properly report issues and enforce regulations because it affects their bottom line.

Sam Brooks is a nursing home advocate who’s been investigating nursing home abuse. He says not only are facilities failing to report abuse or possible abuse, they do not adequately investigate.

He blames both nursing home staff and the State Dept. of Health that is responsible for overseeing them. He looked at every inspection report of nursing homes in Philadelphia from 2012-2014.

“We found 9/10 if you filed a complaint against the facility the Department of Health was not substantiating that complaint. So hundreds and hundreds of complaints were dismissed,” said Brooks. “What we were shocked by is over 3 years of complaints in Philadelphia we didn’t find one violation for sexual abuse or purposeful harm,” said Brooks.

Slate had an interesting article discussing how and why the uninsured rate has gone up after Trump’s sabotage of ObamaCare.  But there’s an odd political caveat: At the moment, the uninsured rate only seems to be rising for Republicans.

The share of working-age adults without health insurance has increased for the second year in a row, according to a new report by the Commonwealth Fund. In the group’s latest annual tracking poll, 15.5 percent of Americans between 19 and 64 said they lacked coverage, up from 14 percent last year and 12.7 percent during President Obama’s final lap in office, when the uninsured numbers hit a historic low.

The Commonwealth Fund isn’t the only organization to find a drop in health coverage. Gallup’s last tracking poll found that the uninsured rate had risen 1.7 percentage points since the end of 2016. To some extent, that’s not surprising. The White House’s attempts to undermine Obamacare have driven up the sticker price of health plans sold on the individual market, which has surely led some people to drop their coverage. What’s somewhat more puzzling is that both Gallup and Commonwealth find that the biggest drops in coverage have occurred among lower-income households, who typically qualify for subsidies under the current health law. Commonwealth found that the entire decrease in coverage last year occurred among households making less than 250 percent of the poverty line.

Rising uninsured rate
Commonwealth Fund

That’s a bit odd because, for the most part, lower-income families should not have seen the cost of their insurance go up much, if at all, since the Affordable Care Act caps their premiums at a percentage of their income. In fact, the cost of insurance ended up dropping for many subsidized insurance customers this year, because of how states reacted after Donald Trump cut off certain payments to insurers. And while it’s true that Republicans repealed the individual mandate as part of their tax law, that change doesn’t take effect until 2019. At the moment, Americans are still required to buy coverage as before.

 One of the most puzzling findings in the Commonwealth Fund report is that, last year, the uninsured rate only increased among Republicans. That’s surprising, since even in deep red states that didn’t expand Medicaid, many low-income minority communities where people are at risk of falling into Obamacare’s coverage gap tend to vote Democrat. And yet, Commonwealth found no statistically significant change in the uninsured rate among Democrats or independents; among Republicans it rose 4 percentage points.

Uninsured rate by party
Commonwealth Fund

CNN Money published an article on the lack of available positions in nursing schools despite the nursing home industry’s repeated complaints of a nursing shortage.  Schools are turning away thousands of qualified applicants as they struggle to expand class size and hire more teachers for nursing programs.  In America, experienced nurses are retiring at a rapid clip, and there aren’t enough new nursing graduates to replenish the workforce. At the same time, the nation’s population is aging and requires more care.

There are currently about three million nurses in the United States. The country will need to produce more than one million new registered nurses by 2022 to fulfill its health care needs, according to the American Nurses Association estimates.  Robert Rosseter, spokesman for the American Association of Colleges of Nursing, said  “There’s tremendous demand from hospitals and clinics to hire more nurses,” he said. “There’s tremendous demand from students who want to enter nursing programs, but schools are tapped out.”

In 2017, nursing schools turned away more than 56,000 qualified applicants from undergraduate nursing programs. Going back a decade, nursing schools have annually rejected around 30,000 applicants who met admissions requirements, according to the American Association of Colleges of Nursing.

Forbes had an article about the difficulty of relying on nursing homes to take care of our loved ones.  “When your loved one is admitted to a nursing facility, you are at their mercy. There is a significant imbalance of power in many ways and many families may find themselves feeling completely lost.”

We expect that the people with the most experience will hold our hands and help us through this difficult period, however, this is not always the case. Unfortunately, the situation for seniors continues to deteriorate and, as family members try to grapple with mounting issues it can take a toll on their relationships.

Poor Organization

One of the first things you should determine is whether there is a clear chain of command at the nursing home. Immediately find out who you should contact with all of your questions. If they rattle off different names in different departments, INSIST that you work with ONE person to avoid confusion. 

Not only are there a lot of moving parts in nursing homes but there may be a high turnover rate among employees. Who you spoke to yesterday may be gone tomorrow. As such, try to maintain contact with the highest level staff member and know who you need to go to as a backup.

Misinformation

In workplaces where employees come and go, you may notice that a lot of people are confused about their own roles. Whether the staff members are new, poorly trained or even disinterested in their job, this is problematic because you are relying on these people for information.

To combat this issue, again, try to discuss things with one person and document every single interaction. To make this easier, consider making email your primary mode of contact. You will have a written record of everything that has been said which may come in handy if a dispute ever arises (and it probably will).

Staffing Issues

Not to sound like a broken record but nursing homes really do struggle to keep employees, especially the good ones. You may quickly discover how much this affects the quality of care at many different levels.

From poorly maintained rooms to poorly maintained records, an understaffed senior residence can be a dangerous place but there may be little that you can do. Sadly, this isn’t an uncommon issue and seniors could be left feeling neglected. Be friendly with the staff and show them you are invested. This will send the message that you are kind but also vigilant.

Medical Malpractice

In the worst-case scenario, a nursing home resident can be physically or mentally harmed by negligent medical care. This, unfortunately, can have permanent consequences and may even result in their death.  As a result, the anger and pain that stem from these situations can tear a family apart. By being proactive, however, you can improve your odds of a better experience.

What You Can Do

I’ve mentioned it once but I’ll say it again – document EVERYTHING. Do your best to keep important conversations restricted to email but, if you do have an in-person discussion, you can always follow-up with that person and recap everything that was said. Again, this provides you with a paper trail.

Do some research and contact every senior resource in your area including the Department of Social Services, Medicaid, Medicare and everything in between. Get the correct information from the source and double-check anything the nursing home tells you.

You can also enlist the help of the local Ombudsman and/or an attorney that specializes in elder law. Not only can they help you navigate this confusing time in your life but they can be especially helpful if anything goes wrong.

No matter what, understand that this is going to be a stressful chapter in your family’s history. Any problems that already existed could easily deepen under these circumstances. Try to always give each other the benefit of the doubt, listen with an open heart and focus your energy on making memories with your aging loved one. Everything can change in an instant so make the most of every moment.

 Nursing home opposition hasn’t slowed a proposal to let Louisiana families install video camera systems in their loved ones’ nursing home rooms. Under the legislation, the cameras would be voluntary. The costs would have to be paid by the nursing home patient or family member. Any roommate — or a legal guardian — would have to agree to the camera installation. Nursing homes would be prohibited from ousting or retaliating against residents who choose to install the monitoring device.

Supporters said it would give family members the ability to monitor their loved ones from afar.  The nursing home industry lobbyists allege that live-streamed video could be hacked, facilities’ private medical records could be targeted and privacy could be threatened.  Many state senators seemed incredulous at the ridiculous objections raised by the Louisiana Nursing Home Association.

“I mean, really?” said Sen. Norby Chabert, a Houma Republican who pushed back against the claims.   Chabert said the nursing homes’ opposition seemed to suggest they don’t want people to be able to see their family members in real time. “That’s kind of fishy to me,” he said.

Supporter Lucie Titus, who said her mother, an Alzheimer’s patient, was unable to explain injuries she suffered in a nursing home. Titus asked to install a video camera system in her mother’s room and was refused by home administrators. She believes if she could have seen what caused her mother’s injuries, treatment could have been quicker and involved less pain. Titus filed a lawsuit to set up the video monitoring, but her 92-year-old mother died in November 2017 before the issue was resolved.

The Arkansas Times reported the suspicious and mysterious payment from the nursing home industry to legislators considering tort reform.  The Southwest Times Record continues its excellent reporting on a mysterious payment sent by a major player in the nursing home lobby to a company owned by former state Sen. Jake Files (previous coverage on Arkansas Blog here). Files pleaded guilty in federal court earlier this year to unrelated charges of wire fraud, bank fraud and money laundering.

An $80,000 wire transfer from a nursing home executive (a business partner of nursing home magnate Michael Morton) was sent to Files’ company in 2014 just a week after an effort was filed to legislatively refer a proposed constitutional amendment to voters that would have limited damages in civil lawsuits. The situation looks smelly enough that a county prosecutor recently wrote a letter to a federal prosecutor asking whether the transfer had been made in “violation of federal law,” an FOI request by the Times Record revealed.

Previous reporting by the Times Record uncovered the $80,000 wire transfer to Files’ Fort Smith company FHH Construction from David Norsworthy, part-owner in more than a dozen nursing homes in the state with Michael Morton. The transfer took place on Nov. 24, 2014 according to documents provided to the Times Record. A week earlier, on Nov. 17, 2014, a resolution was filed by Sen. Eddie Joe Williamsone of the nursing home lobby’s most reliable soldiers, to send a proposed constitutional amendment limiting civil damages to voters.

That resolution ended up dying in committee (a follow-up attempt to get the measure on the ballot by petition was ultimately blocked by the courts). However, a similar effort in 2018, co-sponsored by Files, will be on the ballot as Issue 1 this fall, the so-called “tort reform” amendment. The measure is strongly supported by the nursing home lobby. It would impose caps on the damages that places like nursing homes would have to pay out if a jury found that abuse led to pain, suffering, or death.

Norsworthy — who in addition to co-owning nursing homes has also been a business partner of Morton’s in a health insurance company for Medicare Advantage patients, Arkansas Superior Select — is a board member of Arkansas Health Care Association, the lobbying arm of the nursing home industry (which is pushing hard for Issue 1). In 2014, when Morton’s term was up for his seat on the state commission that oversees the issuance of permits to nursing homes, Governor Hutchinson tapped Norsworthy to replace him (Morton was under federal investigation at the time). Norsworthy continues to serve on that commission; his term is up this year but he plans to re-apply, according to commission staff.

Morton funneled large amounts of money in recent years to various candidates friendly to his interests, in part via a scheme arranged by Gilbert Baker, the former state legislator and lobbyist. The defrocked judge Mike Maggio pleaded guilty in 2015 to taking a bribe to reduce a verdict by millions of dollars in a negligence case involving one of Morton’s nursing homes, around the same time that Baker had arranged multiple contributions from Morton to Maggio for a planned campaign for Court of Appeals. Baker and Morton deny any wrongdoing and have not been charged.

Baker’s partner, Linda Leigh Flanagin, was with Baker when they approached Morton about Baker’s scheme to set up multiple PACs (thus dodging campaign contribution limits) that could funnel additional Morton dollars to candidates, including Maggio. In a deposition, Flanigan also described meetings she had with Morton to discuss efforts to enact “tort reform” to limit damages for maltreatment by nursing homes.

As for Files, about six months after his company received the $80,000 from Norsworthy, he received a $30,000 loan from lobbyist Bruce Hawkins, as first reported by the Arkansas Blog.  Hawkins’ name came up at the periphery of the Maggio case.  Hawkins had used the same attorney Baker had, Chris Stewart, to set up a series of political action committees for a similar bundling scheme. Those PACs received some of the money aimed at Maggio. In a deposition, Hawkins testified that he moved to distance himself after he got tied up through news articles in the effort to aid Maggio, in part by a contribution made by Stewart from one PAC without Hawkins’ approval.

Files got into his own hot water with federal investigators in a separate matter related to misuse of General Improvement Fund money appropriated by the legislature in 2016 and pledging a forklift he did not own as collateral for a $56,700 bank loan. Files admitted to misdirecting more than $25,000 in taxpayer money for a sports complex his construction company was supposed to build and pocketing GIF funds for personal purposes. He faces sentencing in federal court this summer.

The Tribune reported the tragic consequences of allowing a nursing home resident to smoke without proper supervision and safety attire.

The father of a 55-year-old mentally impaired man living at a nursing home in San Luis Obispo alleges that staff there negligently gave the partially paralyzed and wheelchair-bound man a cigarette and lighter shortly before he was found in a patio area “engulfed in flames.”  Compass Health, Inc., owns and operates Mission View Health Center.

A lawsuit filed by Floyd Lewelling, on behalf of his son Jeffrey Lewelling, says that staff at Mission View  should not have given the man his own lighter nor left him alone in the designated smoking area.  They should also provide a smoking apron.

The Lewelling family seeks an unspecified amount of monetary damages for dependent adult abuse and neglect, negligence and violations of resident rights.

Fox2Now had a sad story about a nursing home resident covered in bruises with no explanation.  Bessie Wamsley is laying in a hospital bed covered in bruises and bumps. She has two black eyes, bruising inside her ear and marks on her face and neck. Doctors tell her family they don’t think she’s going to survive.  Her family is demanding answers as their grandmother lies in a hospital bed covered in bruises. The injuries occurred while she was in the care of Country View Nursing Facility in Bowling Green.

“The doctors kind of have the feeling that whatever happened to her lead up to the seizure and the stroke,” says Bella Avila.  The facility never notified her family that her grandmother was hurt because they don’t have power of attorney.  Staff later told them Bessie fell out of bed.

Police obtained Bessie’s medical records that show she was taken to the hospital for a fall on April 19 and was sent back to the nursing home. She says according to police, 10 days later she was sent back to Pike County Memorial and then flown to DePaul Hospital.

“Then the doctors and nurses came in to talk with us and said that if it happened on April 19, the bruising wouldn’t be that fresh,” she says.

“She can’t move. I don’t see her going out of bed. She can’t walk. She can’t be on her own let alone roll herself up,” says Jennifer Reeves, her other granddaughter.

This isn’t the first time the family has noticed injuries.

“She’s had many bruises before. They said she bumped it on the table or that she’s on blood thinners, so she bruises easily, and they always just kind of blew us off. We went up there before and she was missing a fingernail and we asked how and they said she slammed it in her drawer or something,” says Avila.

“I want my grandma back. I want justice for whatever happened. There’s other families that could be going through this and it’s not fair to them. We need answers,” says Reeves.

 

Freelance Contribution by Karen Weeks

Having a conversation with a loved one about their end-of-life arrangements can be overwhelming and can lead to anxiety, depression, and stress for everyone involved. Whether it’s due to a long terminal illness or advanced age, it can be extremely difficult to think about the next phase for your loved one, and it’s never easy to figure out how to begin.

One thing to keep in mind is that this topic should be approached with compassion and care. Remember, too, that there may be many people affected by these arrangements, so it’s important to take them into consideration as well. Think of the best ways to gently broach the subject so that you can help your loved one as much as possible during this difficult time, and remember to include your siblings or other close family members in the conversation when the time is right. If you’re unsure about timing, read this helpful guide.

 

Some ways to get started include:

 

Looking for an opening

You may feel at a loss for how to bring up making arrangements, so think about what your loved one’s needs might be. If they’re ill, ask them if there’s anything they want to talk about, or whether there is anything they need help with. Often, this will open up the path for a frank discussion about the next steps. If your loved one is of an advanced age, it might be helpful to ask whether there is anything they want to take care of or anything you can help them accomplish.

 

Finding comfort

If your loved one finds comfort in the church, talk to the pastor or priest in charge and ask about any ideas they may have about beginning the conversation. They may know of a sermon, song, prayer, or Bible passage that will help your loved one during this difficult time, or they may be able to make a home visit to give your family comfort.

 

Talk…and listen

For individuals who are facing the end of life, there are many conflicting emotions, and some can be overwhelming. They may be worried about how their family members will fare without them, or they may have a long list of things they wanted to accomplish. They may be in pain, either physical or emotional, and not know how to talk about it. Having a conversation with your loved one about their feelings is a great way to help them come to grips with the reality of their situation, but it’s important to listen to them as well. Let them vent, and refrain from using statements that are made purely for comfort, such as “You’re going to be around for a long time.” Doing so will only create false hope and diminish your loved one’s feelings.

 

Consider asking for help

For many people who are living with a terminal illness, hospice care is a wonderful choice. It allows for a measure of dignity while assisting with arrangements and end-of-life care. Do some research into local hospices alongside your loved one and find out about payment options and exactly what they offer.

 

Wills and advance directives

Ask your loved one if they have a will or advance directive in the event of their hospitalization. Having a plan may help them feel that loose ends are tied up and allow them to face the end without stress or anxiety. You can find more information on advance healthcare directives here.

Remember that your loved one may have a hard time talking and thinking about their end-of-life arrangements, so let them guide the conversation after you begin. If it’s too overwhelming for them, allow them to rest before you bring it up again, or try a different approach.

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