Cleveland.com reported that a former nursing home worker was indicted Oct. 20 after a detective investigating thefts from elderly residents found her using one of the stolen credit cards at a Cleveland bingo parlor.  Gwendolyn Brice faces multiple charges including identity theft, after an officer showed her photo to a bingo worker on Oct. 12, who told him she was in the building — then gave him the name on the stolen credit card she had used that night to purchase $140 worth of bingo cards and supplies that night.

The detective had already noticed the suspect standing in line purchasing materials and knew it was the name of one of what may be multiple victims, as the investigation continues after her Oct. 13 arrest and subsequent grand jury indictment. Brice had access to the residents’ rooms and was employed at Hamlet Hills nursing home for 10 months.

Michael Freeman sent me this press release about a recent survey of people with Medicare prescription drug benefits.   Medicare’s Part D prescription drug coverage program is maintaining its exceptionally high popularity among the nation’s older Americans, with a new survey showing that 88 percent of beneficiaries are satisfied with the program and 95 percent saying they have greater peace of mind as a result of Part D coverage.

The survey of 992 Medicare beneficiaries, of which 403 have Medicare Part D coverage, was conducted by KRC Research. It was commissioned by the Medicare Today coalition, an alliance of more than 400 national and local organizations committed to providing seniors and near-retirees with reliable information on Medicare benefits and program changes.

“Medicare Part D has reached popularity levels that you seldom, if ever, see from a government program,” said Mary R. Grealy, president of the Healthcare Leadership Council and co-chair of Medicare Today. “Over the last five years of satisfaction surveys, Part D has stayed consistently above an 80 percent approval rating. And given the fact that competition is keeping the program affordable – and that average premiums won’t increase in 2012 – satisfaction should stay very high.”

Among the key findings from beneficiaries with Medicare Part D plans:

• 95 percent say their current Part D plan works well, with 94% saying it is easy to use.

• 82 percent say their Part D plan offers good value. Beyond that, 67 percent saying they have lowered their prescription drug spending. That’s an eight percentage point increase since 2006. Also, 34 percent say they used to skip or reduce their prescription medicine doses to save money, but now no longer have to do so.

• Part D popularity transcends partisan political lines. Among self-identified Democrats, 91 percent are satisfied with their Part D coverage, compared to 89 percent of Republicans and 80 percent of independents.

• The high satisfaction rate is reflected in the number of beneficiaries who say they will likely shop and compare competing Medicare Part D plans during the open enrollment period. Two of every three seniors said they are unlikely to shop around.

More information on the Medicare Part D satisfaction survey can be found at www.medicaretoday.org.

About the Survey: KRC Research conducted a random-digit-dial landline telephone survey of 992 seniors 65 years and older who are enrolled in Medicare. Of those, KRC interviewed a total of 403 seniors with Medicare Rx plans, half with stand-alone plans and half with Medicare Advantage plans. The margin of error for a sample size of 403 beneficiaries with Medicare Part D is plus or minus 4.9 percentage points.

Vermont Gov. Peter Shumlin made history earlier this year when he signed into law legislation that would make his state the first state to lay the groundwork for a single payer health care system.  Vermont begins building a single-payer health system that will move many state residents into a publicly financed insurance program and pay hospitals, doctors and other providers a set fee to care for patients.   "Under the plan, single payer coverage will be a right and not a privilege, and will not be connected to employment," he wrote in a recent blog post. "This is groundbreaking. But our success in guaranteeing coverage depends on our ability to control health care costs, so our plan is focused squarely on that goal."

Now, another governor is looking to take advantage of flexibility in Obama’s health care law in order to establish a single payer system in his state. Gov. Brian Schweitzer (D-MT) announced that he will be seeking a waiver to set up his own universal health care system in his state modeled after the single payer Canadian health care system.

Gov. Brian Schweitzer will ask the U.S. government to let Montana set up its own universal health care program.  The popular second-term Democrat would like to create a state-run system that borrows from the program used in Saskatchewan. He said the Canadian province controls cost by negotiating drug prices and limiting non-emergency procedures such as MRIs.

Here are some of the issues involved:

Green Mountain Care would be a state-funded-and-managed insurance pool that would provide near-universal coverage to residents while reducing health care spending.   The law allows for either a completely public system or a public-private venture where the state could contract out some administrative functions to private insurers. Employers with self-insured plans (usually large companies) would be able to keep their current health coverage.

 Supporters say that a single-payer system is friendly to consumers and providers and will help reduce the rate of health-care cost increases. A Commonwealth Fund report concluded that such a system could cut health care spending by 25 percent after it is fully implemented. After adding coverage for the uninsured and expanding other services, including dental care, the system would save Vermont households and employers nearly $200 million in the first year alone. Savings would come primarily from lower administrative expenses, reduced fraud and abuse, greater delivery system integration and malpractice reform. The report also found that the system would create about 3,800 new jobs and increase the state’s total economic output by more than $100 million in 2015.

Dr. David Himmelstein, a professor at the City University of New York’s School of Public Health and a proponent of a national single payer system, said: "If they follow through like they say they would, it would be a fabulous thing, an enormous gift to the nation."

Meanwhile, some single-payer advocates believe that the new system does not go far enough. Himmelstein said that the law should be more explicit about not having copayments and deductibles and make a greater commitment to global budgeting, in which providers pay for a patient’s healthcare with a set fee for the year.

 

Christine Seivers works with Medicalbillingandcoding.org, where she just published a post entitled, “Top 9 Health Care Systems in the World” Considering this overlap in subject matter with our blog, we thought we would share the article with our readers.

"There has been much debate in recent years about whether health care is a privilege or right. While securing coverage for every U.S. citizen has been a priority for years, people often overlook the overall quality — or lack thereof — of our health care system."

Many of the countries listed have universal coverage for all citizens and they spend less than Americans do on health care but get better results.  The L.A. Times recently reported that the U.S. healthcare system is lagging further and further behind other industrialized countries on major measures of quality, efficiency and access to care, according to a new report from the nonprofit Commonwealth Fund, a leading health policy foundation.  Americans die far more frequently than their counterparts in other countries as a result of preventable or treatable conditions, such as bacterial infections, screenable cancers, diabetes and complications from surgery.

 

 

The New York Times recently ran an incredible article by Jane Gross who is a former New York Times reporter and the author of “A Bittersweet Season: Caring for Our Aging Parents — and Ourselves.”   Below are excerpts:

HERE is the dirty little secret of health care in America for the elderly, the one group we all assume has universal coverage thanks to the 1965 Medicare law: what Medicare paid for then is no longer what recipients need or want today.

No one then envisioned the stunning advances in medicine that now keep people alive into advanced old age, often with unintended and unwelcome consequences. Indeed, scientific reports have showed the dangers, not merely the pointlessness and expense, of much of the care Medicare is providing.

Of course, some may actually want everything medical science has to offer. But overwhelmingly, I’ve concluded in a decade of studying America’s elderly, it is fee-for-service doctors and Big Pharma who stand to gain the most, and adult children, with too much emotion and too little information, driving those decisions.

In the last year alone, and this list is far from complete, here is what researchers have found both useless and harmful, according to leading medical journals:

Feeding tubes, which can cause infections, nausea and vomiting, rarely prolong life. People with dementia often react with agitation, including pulling out the tubes, and then are either sedated or restrained.

Abdominal and gall bladder surgery and joint replacements, for those who rank poorly on a scale that measures frailty, lead to complications, repeat hospital stays and placement in nursing homes.

Tight glycemic control for Type 2 diabetes, present in 1 of 4 people over 65, often requires 8 to 10 years before it helps prevent blindness, kidney disease or amputations. Without enough time to reap the benefits, the elderly endure needless dietary limits and needle sticks.

Yet Medicare, which pays for all of the above, does not, except in rare instances, pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet.

Nationwide, the median annual cost of a nursing home in 2010 was $75,000; room and board in an assisted living facility, with no additional help, was $37,500; and the most basic category of home health aide, who can perform no medical tasks, like the dispensing of medication, was $19 an hour. These expenses are left to the elderly (and their adult children) to pay for out of pocket until their pockets are all but empty.

A recent state-by-state study of long-term care, the first of its kind, by a consortium of researchers, has found that this kind of essential help costs anywhere from 166 percent to 393 percent of the average annual income of America’s elderly.

This mismatch between what is covered and what is actually useful is the central flaw in Medicare today, a shock to families who have no clue, until they’re smack in the middle of it, about how this system works.

This mismatch tortures our elderly, drains the Medicare trust fund and leaves adult children with depleted retirement reserves. Yet in all the debate about the national debt, medical inflation and the need to pare Medicare costs by such means as raising the eligibility age, why is nobody, outside the insular community of long-term care providers, even mentioning the difference between acute and chronic care and how each is paid for (or not)?

The current system is unsustainable, but the alternative is the third rail of health care policy. President Obama’s original legislation included Medicare reimbursement to doctors for discussion of end-of-life issues. These are what Sarah Palin called “death panels”; days later, they were cut from the legislation. An Independent Payment Advisory Board will make recommendations to Medicare about what works and what doesn’t, beginning in 2015, but its proposals are not binding, as intended. A long-term-care insurance provision — with an average daily benefit of a mere $50 — is under siege.

 

Nick DiMarco reported the arrest and indictment of nursing home employee Shirleen Diane Sheppard on charges of abuse, neglect and assault on a resident.  Sheppard is charged with second-degree abuse of a vulnerable adult, two counts of second-degree neglect, and one count of second-degree assault, online court documents show.

The charges stem from an incident that took place on Oct. 17, 2010 at Stella Maris, Inc. 

“Abuse and neglect of a vulnerable adult are misdemeanors punishable by up to five years in prison and a $5,000.00 fine for each offense,” neglect and assault on an elderly resident at a Timonium care facility, according to a release from the Office of the Attorney General. “The second-degree assault charge, also a misdemeanor, carries a sentence of up to 10 years in prison and a $2,500.00 fine.”

 

 

An uninsured skilled nursing home operator was found liable yesterday of abusing an elderly resident. After the jury returned a verdict that would have led to a $1.5 million liability and an expected punitive damage verdict in the range of $20 million soon to follow, Erwin Cablayan, shareholder of San Marino Manor, Inc., cavalierly advised the trial court that San Marino Manor had filed bankruptcy.

Cablayan and his legal defense team of lawyers attempted to stave off litigation by informing the Plaintiff that the nursing home operated without insurance.  Most nursing home do not carry insurance or it is a wasting policy that goes to defend the owners but not to pay verdicts for abuse and neglect. 

"We have been tracking for about three to four months how they began transferring assets to a shell corporation, which put Erwin Cablayan’s son Kevin Cablayan ostensibly in charge,"  attorney Garcia said. "As if they had not already abused Mrs. Angelo enough, now they are going to try to defraud their way out of responsibility for abusing elders."

Garcia continues, "I’ve known since Day One that the Cablayans, as shareholders of Coordinated Care, would refuse to pay any verdict. They seemed to believe that this would cause us to dismiss the case and allow them to go on their merry way. They were wrong. The jury very clearly confirmed the abuse of our client Mrs. Angelo. And, quite candidly, we will not rest until justice is obtained for Mrs. Angelo and abusive corporations, such as San Marino Manor, with indifferent shareholders, such as the Cablayans, are put out of business."

Reyes C. Angelo vs. Coordinated Care Center, Inc. dba San Marino Manor and DOES 1 through 250, inclusive (Case No. 6C038713) was heard in Superior Court of the State of California, Northeast Division.

Angelo’s death on March 16, 2006, was referred by an investigator to the Los Angeles County Coroner’s office as a suspicious death. The coroner found her death to be caused by infection of accumulated pressure sores.  Laboratory results indicating malnutrition and dehydration were also never revealed to the family.
After admission, Angelo had developed more than 10 pressure sores on her toes, hips, lower buttocks, inner thighs, inner buttocks, and coccyx, with more than half of them Stage IV pressure sores. Many of the sores became black and necrotic, and later were found to be infected with MRSA.  The pressure sores were in places easily hidden from the family by bandages and clothing. It was not until Jan. 20, 2006, when Angelo’s daughter found Angelo sitting in a wheelchair over a puddle of urine and in a urine-soaked diaper with fecal matter with her bandages saturated, that the family realized Angelo’s medical condition.

At the family’s insistence, Angelo was transferred on Jan. 21, 2006 to the hospital. A staff person rode with Angelo, bringing her medical records with her. Upon returning to San Marino Manor, Angelo’s medical records were rewritten and adapted to cover the lack of care Angelo had received.  For example, the records that went to the hospital demonstrated that Angelo did not receive numerous doses of diabetic insulin she was prescribed. In the nursing home’s copy of medical records, all of the doses were filled in.

The admitting doctor at the hospital noted Angelo’s condition, including extensive pressure sores, many of which were infected and black and necrotic, and that they indicated that she had been left to lie on her side for long periods of time. He also noted that Angelo was suffering from diarrhea, vomiting, and malnutrition.

Coordinated Care Company, Inc., the parent company of San Marino Manor, is headquartered in San Diego, Calif. It is owned by Erwin Cablayan, who also owns the Bradley Gardens in San Jacinto in Riverside; Senior Day Centre of Hemet Valley and Cherry Valley Healthcare Management Center in San Marcos; Bradley Court Convalescent Center in El Cajon; and Tri Care Center, Inc., headquartered in San Diego. In Colorado, Erwin Cablayan also owns Aspen Siesta, also known as Coordinated Health Center.

For more information, contact Stephen Garcia at www.lawgarcia.com or at (800) 281-8515.

 

See article from PR Newswire.

The Sacramento Bee wrote an incredible series of articles about the edpidemic of false and fraudulent charting in nursing homes.  The practice of nursing homes altering patients’ medical records masks serious conditions and covers up care not given. A Bee review of nearly 150 cases of alleged chart falsification in California reveals how the practice puts patients at risk and sometimes leads to death.  We see it in every case.  Care documented that was clearly not given even notes when the residents was not in the facility.  Excerpts of the recent editorial are below:

Nursing homes make record- keeping mistakes. Sometimes the mistakes are innocent. Sometimes, as The Bee’s Marjie Lundstrom has demonstrated in her investigative report on bogus nursing home record-keeping, they are deliberate – a pattern of deception intended to lull family members into believing that their loved ones are receiving appropriate care and to protect corporate nursing homes from lawsuits when a patient is seriously injured or killed.

That overworked and understaffed nursing home personnel might fail to document all of their actions is understandable but also dangerous. Of course, when they falsify their actions, it’s criminal.

The cases described in The Bee series show that sloppy and false record-keeping can be deadly. In some of the cases reviewed, those who signed medical reports did not exist or were not working the days they claimed to have performed the services. In other cases, nursing home workers say they were ordered to alter records. Detection and prevention is not always easy.

 

Maryland Attorney General Douglas F. Gansler settles with Mariner Health Care, Inc. and Sava Senior Care Administrative Services, LLC, two nursing home chains operating out of Atlanta, Georgia. They are owned and operated by Murray Forman and Leonard Grunstein who are presently in litigation with partners and investors in New York.  The settlement will return only $137,735.51 to the Maryland Medicaid program.  The amount of the kickbacks are unknown but some estimate them to be over $50 million dollars of tax payer funds.  See article at CityBizList.

"The states and federal government have received a total of $14 million in civil damages from Mariner and Sava to compensate Medicaid and Medicare programs for harm suffered as a result of this conduct. The settlement resolves allegations that the defendants solicited and received kickback payments from Omnicare, Inc. ("Omnicare"), the nation’s largest pharmacy that specializes in dispensing drugs to long term care facilities."

 

 

The Hartford Courant reported that health regulators fined Regency Heights for failing to provide patients with their medication for serious conditions including heart disease and dementia.  The inspection by the Department of Public Health confirmed that several hundred doses had been omitted from treatment regimens at the 190-bed facility.  The missed doses, some of which were found on the nurses’ drug cart, and still in their blister packs, involved drugs to control seizures, heart disease, diabetes, cerebral-vascular injuries, schizophrenia, Alzheimer’s and behavioral disturbances.  The inspectors listed 18 patients who had received only a portion of the drugs prescribed to them over the previous three to four months.

The health department only assessed a $3,000 civil penalty for "a probability of death or serious harm in the reasonably foreseeable future.”