I have been surfing around on the internet today, and was looking at one of David Swanner’s most recent blog posts, where he talks about Stephanie Mencimer’s blog, The Tortelinni.  That led me to a post on there about tort reform and nursing homes.  That got me thinking . . .

This is an issue we deal with a great deal, and that we fight against every day – the idea that "frivolous lawsuits" are increasing insurance premiums for nursing homes to the point that they might have to close their doors.  Never mind the evidence the feds are not providing the oversight needed to prevent abuse and neglect in nursing homes in the first place.  Nevermind the amount of money some nursing homes are making.  Just look at this example.  $959 million in one quarter?!

What no one is talking about is the actual lawsuits being filed against these nursing homes.  What no one thinks about is what if it was your mother, your father, your husband or wife who lived in a nursing home where staff wouldn’t answer the call bell to take them to the bathroom, forcing them to lie in their own feces or urine for hours – add to that pressure sores without bandages, so that urine and feces soak into open wounds.  What no one thinks about is what if your family member was given the wrong medication which led to brain damage or even death?  This is not made up stuff, these are the kinds of cases we see all too often.  Put yourself in that position, and then lets talk about "frivolous lawsuits."

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Drug-maker freebies can lead to harm for patients, a new report from the highly respected New England Journal of Medicine warns. Consumers have reason to be concerned about the study’s findings.

Gifts (bribes?) showered upon doctors by drug- and medical device-makers have become so pervasive that they are a standard part of every physician’s practice. 94 percent physicians have a  relationship with the drug industry, according to a study scheduled to be published Thursday in the New England Journal of Medicine.

Consumers should care about such relationships because drug companies market the most expensive brand names; gift-giving influences prescribing behavior and therefore how much patients spend on prescriptions.

The study proves that many doctors do not follow the AMA voluntary guidelines. It notes, for example, that 35 percent of respondents accept reimbursement for continuing medical education or for travel, food or lodging for medical meetings.

A National Survey of Physician–Industry Relationships
E. G. Campbell and Others

I saw this article about a nursing home resident with dementia who killed his roommate and thought "how could this happen?" but then I read an article where a murder suspect was moved to a nursing home.  The suspect was charged in connection with a quadruple homicide. See story here

With the graying of the population and the incarceration of so many citizens on Medicaid, nursing homes will need to adapt at receiving dangerous criminals into facilities. This may lead to violence and tragedy in many nursing homes.

On a related note, there have also been issues with registered sex offenders becoming residents of nursing homes.  More often than not, neither family members nor residents are aware that this is occurring.  We found a website recently that family members and residents can use to search by facility, city or state to see which nursing homes sex offenders are currently living in, and I thought that was a great thing to have – for more information, click here.

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I recently read an interesting article about CNAs in nursing homes.  CNAs change adult diapers, clean soiled residents and help the elderly dress, eat and shower among other duties.  Unfortunately, these employees who handle so much of the daily, essential care needed by nursing home residents are underpaid.  The article states that the average pay for new CNAs is less than $8 an hour, only a dollar or so above minimum wage.

As a result of the low pay and demanding job description, CNA turnover is as high as 170 percent at some facilities.  Dale Patterson, vice president and chief financial officer of Evergreen Healthcare Management says about CNAs, "It’s hard work.  And on a relative scale (employees say) ‘I can flip hamburgers for the same pay or I can take care of old people with incontinence problems.’…So of course turnover is high."  Gary Weeks, executive director of the Washington Health Care Association industry group says that many CNAs qualify for food stamps and other public benefit programs.

Low pay for CNAs also means lower quality of care for residents in nursing homes.  Facilities with high numbers of Medicaid patients report "losing" money because of low government reimbursements for such patients.  Less revenue means lower pay.  These facilities spend an average of 44 fewer minutes on direct care of patients each day, they have more patients spending most of their day in bed and a higher percentage of patients with pressure ulcers.  This adds pressure to the nurses who end up overmedicating residents or using chemical restraints.  Larry Minnix, President & CEO of the American Association of Homes and Services for the Aging backs this theory up by stating "The best proxy for quality that we have is staffing."

Starting pay for a CNA in upstate South Carolina has recently been increased about $8.50 per hour.

The Government Accountability Office (GAO) has finally concluded what we all knew to be true:  Nursing homes go unpunished for the abuse and neglect suffered by residents. See story here

Federal health officials impose only minimal penalties on nursing homes repeatedly cited for mistreatment of patients.  As a result, nursing homes cycle in and out of compliance with federal standards and pose a continued threat to the health and safety of patients.

”Some of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs,” said the report, to be issued this week by the Government Accountability Office, an investigative arm of Congress.

The Department of Health and Human Services ”fails to hold homes with a long history of harming residents accountable for the poor care provided,” the investigators said.

Congress established stringent standards for nursing homes in 1987. In 1998, the GAO reported that ”homes can repeatedly harm residents without facing sanctions.”  About 1.5 million people live in the nation’s 16,400 nursing homes on any given day.

The GAO said federal health officials hesitated to impose fines of more than $200 a day, in part because they believed that larger penalties ”could bankrupt some homes.” Fines are generally so small that nursing homes view them as a ”cost of doing business,” with ”no more effect than a slap on the wrist,” the report said.

Here is a good example where a nursing home was fined for overmedicating a resident and then officials withdrew the fine!

Many residents are totally reliant on staff for care, and rely on the federal Medicare program to pay the bills. The problem at nursing homes is poor staffing.  I just read an article that discusses the issue and explains how and why it is a system wide problem.

The article talks about an investigation that found the staffing shortage wasn’t an oversight.  The homes and their upper management were "padding their balance sheets on the backs of helpless residents in their care".

“They were all trying to make a buck,” said Alan Peak, an FBI agent in the white collar crimes unit. The probe revealed criminal conditions at the nursing homes—residents suffering from bed sores, malnutrition, beatings, neglect—all the result of their management company’s directives to cut costs. Meanwhile, managers rewarded themselves handsomely for their efficiency.

The fraud prosecution is one of the first of its kind. While systematically cutting back on service at the nursing homes, management continued to collect money from Medicare and Medicaid for services they knew were inadequate, or in some cases not performed at all.

The management company and its CEO, as well as the nursing homes, pled guilty last fall to fraud conspiracy charges. In February, the CEO was sentenced to 18 months in prison, and the nursing homes were each fined $180,000. The company president was sentenced April 20 to two months in prison for his role.

 

The Michigan AG is trying to stop the abuse and neglect of nursing home residents.  A Metron’s Greenville Nursing Home is facing a $100,00 fine for what the Michigan Attorney General calls "quality of care deficiencies."

The penalty was imposed against Metron for bed rail issues involving several residents earlier this year. This incident follows criminal charges the Attorney General brought in February 2006 against eight employees of the Metron facility in Big Rapids. The charges stemmed from the death of Sarah Comer in January 2005.

See more information here

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

Georgetown police could not find any physical evidence to corroborate one of the recent complaints filed against Georgetown Healthcare and Rehab in Maryville. In March, police were called to the facility after a resident said he was choked by a nurse.

The incident happened in December but he waited to report it because he was “in fear of possible retribution.”  The nurse denied the charges but was placed on suspension during the investigation. 

The resident was shown pictures of 12 women who work at that facility and was asked to show the investigators the one who choked him. The photo selected was not the nurse he accused of the abuse. There was a inconsistency in part of his allegations.

“Based on this investigation, there is no physical evidence or witnesses to support this allegation,” Investigator Johnell Sparkman wrote in his report. “At this time this case is unfounded.”

Helluva an investigation.

No polygraph examination of the accused? Prior complaints? Interview other residents?

See story here