Regency Nursing and Rehabilitation Centers Inc. nursing home chain will pay the United States $4 million for submitting false claims to Medicare and the Texas Medicaid program, the Justice Department and the U.S. Attorney’s Office for the Southern District of Texas announced today. The Victoria, Texas-based chain currently owns and operates 24 nursing home facilities located through the state.  The amount they stole it undetermined.  The charges included false hours and payment for services not rendered to residents.

The False Claims Act settlement resolves allegations that Regency submitted claims for reimbursement to Medicare and Medicaid for rehabilitation and skilled nursing services that were not reimbursable because the nursing home residents were not qualified for the services, the services were not medically necessary, or they were not supported by adequate documentation.

"Nursing home providers participating in Medicare should be on notice that taxpayers will not absorb the costs of improper or false billings submitted to the government and that the Department of Justice will take action against them for submitting such claims," said Tony West, Assistant Attorney General for the Department’s Civil Division.

 

The Buffalo News had a story about 3 nursing home employees who were only disciplined when the employees did not check on a resident or failed to report him missing for over 11 hours.  The Health Department found that the employees, over an 11-hour period, each noticed that Trent Lockridge was not in his room but did not report it.  The resident either fell, was pushed, or jumped from his second-floor room in Dosberg Manor on the night of Feb. 17, but his body was not found until the next morning.

The Health Department required that the facility discipline the employees involved, put in place new policies for ensuring the whereabouts of all residents and train its employees in the new system.

Health Department investigators visited Dosberg Manor after Lockridge’s death, interviewing staff members and reviewing facility records. Their report found that the first employee had responded to a Feb. 17 call from Lockridge’s roommate requesting help in closing the window. The employee noted that the window was wide open, Lockridge’s glasses were on the nightstand, and his walker was near the window. She neither investigated the fact that he was not in the room nor told anyone about it.  In fact, when first questioned by department investigators, she lied and told them that she had seen Lockridge in his room at 9:40 p.m. She later confessed to a co-worker that this was not the case, the report states.

The second employee, who went into the room at 11 p. m. as part of a daily census of residents, assumed that Lockridge had been hospitalized but did not follow up on this or attempt to confirm it.

The third employee, who was assigned to Lockridge’s floor, stopped by the room at midnight as part of her rounds and also noticed that Lockridge was not in his bed, according to the report. Further, Lockridge’s medical records reflected that staff had helped him take a dose of medicine at 6:30 a. m. Feb. 18, when he was still missing. He was not reported missing until 6:45 a. m., when a nurse said she couldn’t find him. His body had been outside for at least 11 hours in freezing temperatures.

The report concludes that the employees should have notified a supervisor when they saw that Lockridge was missing and that the window was open. It does not name them.  Neither the Weinberg Campus nor the Health Department would say what disciplinary action was taken. Weinberg has agreed to put in place a new system for keeping track of Dosberg Manor residents and to train employees in the new procedures.

 

Tony Bartelme of The Post and Courier had a great article about Alzheimer’s, violence, and a cover up in nursing homes using the story of Dwayne Walls. It is a tragic story and clearly preventable.  Below is a short summary of the article.  Dwayne Walls was a resident of Veterans’ Victory House, a large nursing home near Walterboro, who suffered Alzheimer’s.  One day, they moved Walls to another room and put a dangerously psychotic patient in his old one. His wife warned nurses that Walls would try to return to his old room. "They said they were going to really watch him. But at midnight, I got a call that he had gone to his room and gotten beaten to a pulp," she said.

One night Walls went into another patient’s room and climbed in an empty bed. Moments later, another patient walked in. He was 88 years old and also had dementia.  A nursing aide saw the man hitting Walls with his cane. Walls was on the floor, bleeding and unconscious.  An ambulance took Walls to the emergency room and phoned Walls’ wife, Judy Hand. That night and over the next four days, they told her that Walls had merely fallen; they didn’t mention the beating. Walls spent the next week in bed, and Hand was at his side when he died.   The nursing home’s doctor later would write in Walls’ file that his patient had contracted fatal pneumonia after becoming "immobile," but that the beating didn’t account for this immobility.

The facility had a history of problems. Veterans’ Victory House was completed in 2006 at a cost of $28 million in state and federal money. It has five pavilions, and each is named after a South Carolina veteran. It houses 220 residents, making it one of the larger nursing homes in the state. A sign outside says, "Home of the Greatest Generations."   In December 2006, investigators with the U.S. Department of Justice visited the facility: Staff gave patients wrong foods and medications and too often used physical restraints to control behavior problems. They found that the facility was poorly equipped to handle combative Alzheimer’s patients.

"There appears to be no formal behavior program for residents diagnosed with Alzheimer’s disease, placing residents at heightened risk for the use of physical or chemical restraints to control behavior, and placing them at heightened risk of physical assault by other residents who may become frustrated at their repetitive speech or wandering," investigators concluded.

The state Department of Mental Health owns the facility but has a contract with a private company called Advantage Veterans Services of Walterboro to run it. The company is affiliated with HMR Advantage Health Systems, which is based in Easley and operates 26 nursing homes in South Carolina and elsewhere in the Southeast.

Nearly 80,000 people in South Carolina have Alzheimer’s, enough to fill the University of South Carolina’s Williams-Brice Stadium, and that memory loss isn’t the disease’s only troubling effect: More than two-thirds will exhibit some form of agitation or combative behavior.  Aggressive behavior is a normal part of the brain’s breakdown, nursing homes don’t hire enough people to meet the needs of these patients. Many blacklist Alzheimer’s and dementia patients with histories of aggression, leaving already stressed families and loved ones with few options.

There is no cure for Alzheimer’s, but doctors are zeroing in on its causes. One leading theory involves proteins. Healthy people have stringlike proteins in their brain cells that normally curl like unfurled ribbons. These ribbons help nourish the cells. But in Alzheimer’s patients, these ribbons get tangled, destroying the cells in the process, along with a person’s memories and functions that control behavior.

 As happens with about 70 percent of Alzheimer’s patients, Walls grew more agitated as the disease marched through his brain, though he was by no means the only person in the wing suffering these effects.  In 2008, staff at the Veterans’ Victory House documented in his medical records how another resident pushed him to the floor one month, and how a month later Walls hit another resident in the head with his fist. In June 2008, a resident hit another, who fell into Walls and knocked him to the floor. In July, a staff member found Walls in another resident’s bed, his fists balled.   By August, a month before Walls’ death, staff noted that he was "aggressive to others and himself," particularly when he was scared. But then the storm clouds cleared. Staff noted on the day Walls was beaten that he had no behavior problems and was moving around well.

Walls had fallen and needed to go to the hospital for X-rays, a nurse said. She didn’t mention the beating, or that a deputy had been called to investigate.  Hand drove to Walterboro the next Monday morning for a visit. "I walked into the room and gasped. He was black and blue all over, swollen and on oxygen. I ran out of the room and got a nurse. They came and I asked what had happened." Dwayne had fallen, they told her. Throughout the day, the home’s employees stopped by to visit Walls to see how he was doing.  Later that afternoon, four days after the attack, she approached a staffer. "I said, ‘He couldn’t have possibly gotten that from a fall.’ She looked at me and said, ‘No one told you? He was beaten.’ "  Colleton County Coroner Richard Harvey told her over the phone that the beating contributed to Walls’ death, but she was surprised when the death certificate listed the cause as natural and didn’t mention the altercation. In an interview, Harvey said he did an autopsy but the results showed that Walls died of pneumonia, not from any other injuries.

The doctor wrote the summary in November, two months after Walls’ death, and after an ombudsman hired by the lieutenant governor’s Office on Aging visited the home. The agency had received a complaint about "residents that beat other residents," low staffing levels and "residents sitting in soiled diapers."  After the visit, the ombudsman noted the altercation involving Walls but said the agency doesn’t investigate resident-to-resident abuse.

The ombudsman nonetheless concluded, "There is a shortage of staff," after looking at the facility’s staffing logs. The reports showed the Alzheimer’s unit had just one licensed nurse on duty for 52 patients on morning shifts before and after Walls’ attack. On one night shift, the wing had no licensed nurse at all. The ombudsman asked the nursing home to follow state regulations, which requires at least two licensed nurses during the morning shift and one on the night shift.

More recently, an investigator with the state Department of Health and Environmental Control made an unannounced visit to the home and found it hadn’t properly reported the incident involving Walls and the 88-year-old man who beat him. State law requires nursing homes to report "serious incidents" involving residents who assault others.

 

 

 

People always ask us why DHEC and other enforcement agencies don’t fine facilities who neglect and abuse residents.  There is no one explanation.  Lack of enforcement tools.  Lack of qualified investigators.  Nursing home lobbying and campaign contributions.  Lack of media scrutiny.  I saw an article recently in the Journal Star discussing the limits placed on fines and the importance of monetary fines on quality of care and deterrence.  

The article starts with a simple proposition:  "When a nursing home resident’s minor injury is left untreated and progresses to a major infection that ultimately kills her, the facility responsible should pay a stiff price.  When one resident beats another in a nursing home cafeteria because there’s no staff member there to stop it, or when a male resident’s catheter isn’t checked and he gets a serious infection that still has him hospitalized, or when an octogenarian slides out of her wheelchair and is found dead with its seatbelt around her neck because nobody is watching, there ought to be fines that send a message that that’s intolerable. And when a resident who takes a tumble complains of dizziness and head pain only to be told her problem will get checked out at an eye exam the next day, there ought to be strict accountability – especially when she ends up dying that next day."

That seems pretty straightforward and full of common sense but how do you decide what is a fair and reasonable fine?  Most states limit the amount of fines that a facility must pay.

A recent  ruling from a judge held that the Illinois Department of Public Health’s is limited in fine amounts because State law appears to limit the fines the state can levy for these violations to $10,000 per incident.  The Legislature should amend state law to permit higher fines for abuse and/or neglect. The penalties must be severe enough that negligent nursing home operators will improve the conditions.

The article ends with some basic truths:  Most facilities are understaffed or suffering from burn out.  "Many homes don’t staff above the minimal level required by the government, and the difference is often readily apparent. Adding to the problem is the high turnover rate in a workplace that can pay poorly yet require phenomenal dedication in bleak conditions. It’s often worse in troubled facilities. It’s a tough and trying job in the best of situations."

The residents of nursing homes are society’s most vulnerable. They deserve a dignified and safe environment in which to live.   Increased fines, additional investigators, and improved staffing requirements would go a long way in providing the elderly and infirmed the care they need.

The Tennessean had an interesting article about Silvercare, a company that has found a niche in the nursing home industry that improves the quality of care provided and the resident’s quality of life.   Silvercare Solutions was started in February to capitalize on Medicare rules that required nursing homes to do more to ensure that residents are properly assessed for incontinence and provided with comprehensive care services.

Silvercare brings nurse practitioners to nursing homes to treat residents, relieving the homes of the need to hire specialized staff, find urologists to see the elderly residents in their clinics or transport residents there.   About a third of nursing home residents are incontinent, he said.

Silvercare got off to a fast start by acquiring the private practice of a geriatric nurse practitioner that delivered incontinence services to nursing homes in Philadelphia.  It is using the model of that practice to expand in Tennessee, Pennsylvania and New Jersey, where it operates in 48 homes.

Nina Monroe, director of nursing at client Bethany Healthcare Center here, said the nursing home already is seeing improvements in some residents since signing up with SilverCare about a month ago.  Previously, a gerontologist examined residents with incontinence, she said, adding that having specialized care helps to get to the source of conditions that cause the residents’ discomfort.

One of the founders of Silvercare, Frazer Buntin said he was motivated to launch Silvercare by personal experience; he lost his grandmother four months after she broke her hip hurrying to the
restroom at a Nashville nursing home.   This is a common problem in nursing homes.  Residents need to go to the bathroom; they hit the call bell for assistance. No one responds.  They risk falling by trying to get to the bathroom or they wet themselves and lose all dignity.  Many of the fall cases we handle resulted from the staff’s failure to respond to call bells in a timely manner.

 

Kansa City Infozine had an article about a new study from a University of Missouri researcher which found that long-term care facilities in Missouri saved more than $6 million in the past three years after implementing a quality care improvement program. Savings for the facilities were more than 10 times the program costs.  Of course, the nursing home industry should be improving care because it is the right thing to do instead of doing it to save money but that is another story.

Marilyn Rantz, professor in the MU Sinclair School of Nursing completed a three-year analysis of the Quality Improvement Program of Missouri (QIPMO) and found significant improvements in overall care quality of residents in participating facilities. Last year, a total of 990 residents avoided developing clinical problems, including pressure ulcers, depression symptoms and weight loss, resulting in a total savings of $3.7 million statewide for facilities and health care providers in the state.

The primary goal of quality improvement plans is to improve nursing home care practices. In Missouri, QIPMO is a cooperative service of the Sinclair School of Nursing and the Missouri Department of Health and Senior Services; it was created to pair facilities with gerontological nurse experts. The nurses perform on-site visits to offer technical assistance, care-planning help and clinical consultations. One of the nurses’ primary functions is to identify "best practices" for care procedures and make such information available throughout the state.

"Quality improvement is cost effective for everyone involved," Rantz said. "Focusing efforts to improve quality of care not only helps to improve that care and the positive outcomes for people, but it also saves the industry and facilities money."

In the study, Rantz found that the cost savings for each year exceeded the total program cost by more than $1 million. Statewide trends among residents included improvements in pain, fall reduction and pressure ulcer reduction, and fewer tube feedings and restraint reduction.

QIPMO is funded through Missouri’s Nursing Facility Quality of Care Fund, which is generated from care facilities paying taxes according to the number of beds in their facilities. The cost per facility to use the program was less than $3 per bed.

"The impact on improving the quality of care by expert gerontological nurses consulting in nursing homes is significant in addition to the cost savings for the facilities and health care system in general," Rantz said. "The role of these nurses should be embraced by state agencies, nursing home providers and consumers as an ongoing strategy to continuously improve the quality of nursing home care."

Throughout 2007-08, QIPMO nurses made 855 contacts with 246 different facilities in the state, and they made 417 site visits in 227 nursing facilities. Results showed that facilities who participated did improve, and costs of care problems were reduced.

The study, "Helping Nursing Homes ‘At risk’ for Quality Problems: A Statewide Evaluation," was co-authored by several MU researchers and will be published in the July/August 2009 issue of Geriatric Nursing. For more information about QIPMO statistics, visit: www.nursinghomehelp.org/stats.html
 

Dunn Police in North Carolina are investigating a nursing home after a 78-year-old patient was sexually assaulted by a male staff member, according to reports.  A 43-year-old, male CNA at Magnolia Living Center is under investigation relating to the sexual assault of two female residents.  The first incident involves an elderly female resident at Magnolia Living Center who reported that on May 2 around 10 a.m., a CNA at the nursing home touched her inappropriately.

Nursing Home Director Shelley Tinsley reported the incident to police on May 5, three days after the assault allegedly occurred and one day after the victim initially told another CNA what had happened.  The second incident involving a 51-year-old resident was reported to police on May 12th.  The incidents are currently under investigation as aggravated assaults with sexual motives. The suspected CNA has finally been removed from his position while the investigation continues.

According to other media outlets, the victims remain at Magnolia Living Center for now.

The Herald Tribune has another tragic story about a nursing home employee assaulting an elderly woman in a nursing home.  How can the other staff not know what is going on?  What kind of background check do they actually do? Do they ask for references? Do they check references?

A former nursing assistant at Punta Gorda Elderly Care Center was arrested today and charged with felony elder abuse.   The woman, Letitia Calderwood kicked a 76-year-old woman in the back and slapped her in the face, according to a press release from the Punta Gorda Police Department.

On May 19, Calderwood and two other employees were helping the elderly woman get up from a fall in the bathroom, police reported. Struggling to help the woman, Calderwood kicked her in the lower back while she was still down and then slapped her in the face when she was lifted to her feet, according to the report.

Calderwood and the two other facility employees had difficulty helping the resident to her feet and Calderwood subsequently kicked in her lower back while using a profanity. Once the resident was helped to her feet, Calderwood struck her in the face with an open hand.

Both employees were interviewed by detectives and provided statements describing the incident and the alleged battery and abuse.  Calderwood was interviewed by detectives and admitted to kicking and striking the resident as originally reported. She stated that her actions were done out of frustration although she knew the patient was disabled and had limited ability to stand on her own.

Calderwood is being held without bond at Charlotte County Jail. She faces one charge of battery on the elderly and one charge of abuse of the elderly, both third-degree felonies.

 

The family of a 69-year-old woman has filed a lawsuit against a Chicago nursing home for failing to protect her from being sexually assaulted by a 21-year-old mentally ill resident.  Maplewood Care’s administrator tried to cover up a rape by calling it consensual sex.  It is an example of how mixing frail senior citizens and younger mentally ill residents in nursing homes can lead to violence if facilities do not monitor potentially dangerous residents.

"The only possible reason that you would be in this situation is a profit motive," attorney for the family said. "You want more residents in your facility, but you’re unwilling to pay for the necessary elements to protect all the residents."

Christopher Shelton had been diagnosed with bipolar disorder with aggression when he was admitted to the nursing home in November.  Shelton, a convicted felon and a former resident of the Elgin facility, was readmitted to the nursing home without a proper review of his criminal history. Had the facility checked, it would have discovered Shelton had an outstanding arrest warrant on felony battery charges. The state report showed he had told the nursing home staff in December that he was sexually frustrated, but the facility failed to monitor him.

Shelton was missing at bed check, but no search was made or alarm sounded to alert residents and staff that a young, aggressive, sexually frustrated, convicted felon was prowling the halls of the nursing home. Later, a night shift nurse heard an elderly woman moaning and crying.  The nurse found Shelton in her bathroom, where he was calling 911 to report that someone was attacking the woman.  Paramedics and an emergency room doctor later examined the woman and noted signs of sexual trauma.  Doyle who was the Administrator at the facility downplayed the encounter as consensual sex in a report to the state and encouraged employees to lie about it to cover it up.

The state and federal governments only fined the nursing home $44,400 for violations related to the incident.