Forbes had an article about the Administration’s new plan to decrease the deficit and increase quality of care at nursing homes.  Nursing homes that cause residents to be hospitalized would face penalties if caused by preventable falls, poor infection control, or poor medication management.  Nursing facilities would only lose up to 3 percent of their Medicare payment.

About 40 percent of residents are admitted to the hospital in a typical year, and at least 25 percent are preventable.  A congressional review panel estimates that about 14 percent of patients discharged directly from hospitals to skilled nursing facilities are sent back to the hospital for conditions that could have been avoided.

"Because this is a Medicare penalty, it would only apply to those patients who are receiving rehabilitation or recovering from a hospital stay. It would not apply to long-stay residents receiving Medicaid. However, these changes could easily be expanded to Medicaid as well. This readmission rule is similar to one soon to be imposed on hospitals under the 2010 health law. And while those hospital penalties have not yet kicked-in, they have already fundamentally changed the way those institutions think about their patients. Today, because Medicare pays for admissions no matter what the cause, the current system perversely encourages round trips to the hospital, especially in poor performing facilities with lots of empty beds. After all, a readmitted patient generates revenue. The hospital readmission rule radically changes those incentives."

 

 

The Daily Beast had an article about Reason Magazine’s article titled Medicare Thieves".   According to a 2011 report from the Government Accountability Office, Medicare loses $48 billion in “improper payments” each year, an estimate that doesn’t include bad payments within the prescription drug program.  Sham companies, schemers, career criminals, and unscrupulous providers take advantage of the government’s lax controls over Medicare payments. Taxpayers are lining the pockets of health care criminals.   Between 2007 and early 2011, the federal government won convictions against 990 individuals in fraud cases totaling $2.3 billion. In 2010, it recovered an additional $4 billion through collection of non-criminal penalties on health providers who improperly billed the government

Fred E. Dweck was a surgeon and director of a healthcare business in Miami who swindled Medicare out of $24 million. How the fraud worked:

"Dweck’s gimmick, like the payment system he was manipulating, was simple: He gave the go-ahead to official orders for prescription drugs, staff-assisted insulin injections, in-home visits by nurses, and an assortment of other treatments for an estimated 1,279 different patients, none of whom actually needed treatment. With the help of five nurses who faked bundles of official patient records and payment forms, Dweck raked in cash on the taxpayer tab."
 

This happens every day in every nursing home in the country.  That is why health care costs are so high….without an improvement in the quality of care.

 

Nursing home employee Amanda Tibble pleaded guilty to abusing her patients in Washington County, TN Criminal Court. Tibble pleaded guilty to four counts of willful abuse or neglect of an adult at John M. Reed Nursing Home.  She only admitted guilt to the mental abuse. She took best interest guilty pleas for the two counts of physical abuse of two male patients.  Prosecutors accused Tibble of twisting one man’s hand and bending back another man’s hand.

Meanwhile, lobbyists for the nursing home industry are attempting to manipulate the judicial system in Tennessee to benefit nursing homes guilty of abuse and neglect.  Tennessee is moving toward lighter regulation of nursing homes, fewer state investigations and laws that make it more difficult to bring potentially costly lawsuits against operators.  The legislature placed strict new limits on the rights of nursing home patients and their families to sue nursing homes for poor care. That law also caps the amount a jury can award.  Many nursing homes in Tennessee require patients or their families to sign arbitration agreements waiving their rights to a trial before admission. 

The legislature in 2009 reduced oversight of the 325 nursing homes in the state by eliminating regulations mandating that nursing home operators file detailed reports on adverse events affecting patients. Also eliminated were requirements that the state investigate those incidents.

The tort reform bill sets a $750,000 cap on pain and suffering claims against a nursing home. A higher $1 million cap applies to limited types of cases. Caps do not apply if intentional misconduct is found. Nor is there any cap on economic damages, such as doctor and hospital bills or lost wages.

Data compiled by the federal Centers for Medicare & Medicaid Services show Tennessee ranks fourth out of 50 from the bottom in the number of hours per patient per day provided by certified nurse assistants. It ranks seventh from the bottom in registered nurse hours per patient per day, according to the CMS data.

According to state health officials, current law and regulations require licensed nursing personnel to provide only 0.4 hours of direct care per patient each day. Professor John F. Schnelle of the Vanderbilt Center for Quality Aging said studies have shown that increasing the hours of nursing care provided to patients can improve quality. Several published studies, including a report from the Institute of Medicine and one co-authored by Schnelle, have found links between staffing levels and the quality of care provided in licensed nursing homes.

Despite protests from advocates for the elderly, the nursing home provisions in the tort reform bill included a key provision that brings all claims against nursing homes under the strict limits of the medical malpractice law, eliminating separate claims for negligence and requiring plaintiffs to provide certification that the care provided did not meet local standards. Punitive damages also are limited to $500,000 or two times the pain and suffering claims. Claims under a protection from abuse also will be blocked. The sponsors of these bills were all recipients of large campaign contributions from nursing home political action committees.  Follow the money.

Tennessee does poorly compared with other states in some key quality measures of nursing homes.  Federal officials have said the state has failed in its regulation of such homes. A report issued this year by the U.S. Government Accountability Office gave the state Health Department failing scores for its performance in investigating serious complaints against nursing homes. It said there was a backlog of cases that had gone uninvestigated, and it cited a staff shortage as a factor.

 

 

See article at The Tennessean

 

Often residents of nursing homes complain about neglect and abuse but there concerns are ignored because of lack of evidence.  Allowing cameras in nursing homes would prevent abuse, document fraud, and encourage the staff to provide appropriate care.  Recently, articles in the Minnesota Star-Tribune and the Seattle Times discussed the benefits of cameras in nursing homes.

More families are using surveillance technology and video cameras to help protect loved ones they suspect are being abused or mistreated by caregivers. An Ohio man placed a hidden camera in a desk fan to catch two nursing home workers abusing and hitting his 78-year-old mother. In New Jersey, workers were caught abusing an 87-year-old woman.  In New York, authorities arrested 22 workers after hidden cameras revealed maltreatment of residents in two facilities.

For years, the long-term care industry has fought legislative efforts across the United States to legalize the use of cameras, citing costs and privacy issues.  In 2009, Minnesota legislators approved a law that allows adult foster-care facilities to install cameras for overnight monitoring of vulnerable residents to save on staff costs.  In the two recent Minnesota cases, an assisted-living facility discovered large quantities of medication missing from at least six residents. The facility installed cameras in client rooms and caught an aide on the night shift stealing prescription drugs. In a 2007 case, an assisted-living facility in Chanhassen installed a camera that documented an aide abusing a resident late at night in her own apartment. The video showed an aide "forcefully dragging" the woman from her living room to her bedroom.

Legislation was introduced in more than 15 states, but only three — Texas, New Mexico and Maryland — adopted laws addressing the use of cameras in nursing homes.  Violette King, one of the leading advocates for using cameras, believes they are "the only solution" for family members who can’t be present 24 hours a day. King founded the nonprofit advocacy group Nursing Home Monitors in 1996 after her father suffered abuse while in a facility.

 

Sarah Gaines writes articles for http://www.rntomsnprograms.net/, a website dedicated to providing students with the information and tools needed in order to pursue their RN to MSN programs.

 

She asked us to share the latest article she posted called 15 Startling Statistics About the History of Nursing. Below are my favorites:

1895 Nursing Abundance: An article entitled, “Ambulance Work and Nursing,” published in 1985, stated that there was a nursing abundance at that time: “It was the popular fad of the day, and women all over the country became ‘nursing mad.’ They abandoned their household duties and eagerly sought for admittance into the various training establishments. They donned more or less appropriate costumes, and astonished their stay-at-home sisters by the facility with which they employed abstruse medical terms, and by their gruesome stories of the horrors of the operating room and wards.” 
 
Geneva Convention: The United States had not been a party to the Geneva Convention of 1864, which made the International Red Cross possible. Clara Barton saw the need for the Red Cross in America and plunged into the task of creating it. She carried out this enterprise practically single handed, educating the public through brochures and speeches and paying calls to cabinet heads and Congressmen.

Navy Nurses: The Department of the Navy announced in October 1978 that it would begin assigning women to duty aboard ships. The action was in accord with Navy-sponsored changes to legislation governing the assignment of women contained in the Fiscal Year 1979 Defense Authorization Bill. The action also was in accordance with an applicable judicial decision.

Nurse’s Cap: The nurse’s cap was derived from the nun’s habit and developed over time into two types: A long cap, that covers much of the nurse’s hair, and A short cap, that sits atop the nurse’s hair (common in the United Kingdom). While nurse caps all but disappeared in the U.S., nurses’ caps can still be found in many developing nations, as well as some countries where women still make up the overwhelming majority of nurses.

Nursing Shortage Stats: According to the American Public Health Association’s educational campaign, which addresses shortage of nurses, history has shown that the growth of the nursing supply has not kept pace with the evolving needs of the healthcare industry. Demand for nurses will grow by 40 percent between 2002 and 2020, while the supply will increase by only 6 percent over that same period. Factors that drive the growth in demand for nurses include an 18 percent growth in the population, a larger number of the elderly, and medical advancements. Alternative job opportunities have contributed to the slow growth of people entering the nursing profession as well.
 

The Houston Chronicle  and KSN.com  had articles on the disturbing report of maggots in open sores on a resident’s feet in a Kansas nursing home. Wichita Police are investigating the poor care at Deseret HealthCare and Rehabilitation Nursing Facility in Wichita that led to maggots being found on both his feet. The Department on Aging provides oversight for care facilities in Kansas. Over the past six months the Department on Aging found 18 federal violations at the Deseret Wichita facility.

In a December 2009 inspection, the Department on Aging found 24 deficiencies, and a December 2008 inspection turned up 47 at the home, which is licensed for 93 beds and had 88 residents in April.

 

The Wyoming Star-Trbune reported  the arrest of chief financial officer of the nonprofit Shepherd of the Valley nursing home for stealing nearly $52,000 from it by larceny and obtaining property by false pretenses, according to court records. Perry Vandeventer was charged with two felony counts after a half-year investigation beginning in January, according to the affidavit by Chris Williams of the Casper Police Department.

The discovery of the alleged crimes occurred in January during a financial crisis that threatened to close the state’s largest nursing home in Paradise Valley.  Shepherd of the Valley CEO Jill Hult and the nursing home’s accountant submitted reports to the police about numerous financial discrepancies found during an audit, Williams wrote. Through subsequent interviews and inspections of Vandeventer’s personal finances, Williams found Vandeventer allegedly obtained fraudulent expense reimbursements totaling $23,719.66.

From March 2008 through Jan. 15, 2011, Vandeventer submitted bogus receipts for contractors who never did any work, obtained cash advances for travel including trips he didn’t take, and obtained money for books, education expenses and dues for purposes unrelated to the nursing home’s business, according to the charging document and Williams’ affidavit.

Vandeventer also set up a system for company credit cards that required cash in their accounts before using them, Williams wrote. From July 2008 to Jan. 15, 2009, he used two of the nursing home’s credit cards to buy a computer, books, personal cell phone purchases, meals in Denver restaurants, vehicle repair, and fuel, according to the charging document and Williams’ affidavit.

Vandeventer’s credit card entries included a payment to the Internal Revenue Service and to pay a personal speeding ticket at Casper Municipal Court. He sometimes would seek reimbursements for items he charged on the credit cards. These personal credit card charges amounted to $28,080.05, Williams wrote.

The $52,000 allegedly taken by Vandeventer coincided with six- and seven-figure deficits revealed in the nonprofit facilities IRS Forms 990 from 2006 to 2009 as well as IRS tax liens — a claim on a property to pay a debt — totaling nearly $775,000 filed in August 2010.

Shepherd of the Valley was owned by Luthercare Inc. with a board of directors from local congregations of the Evangelical Lutheran Church of America. The for-profit Minnesota-based Mission Healthcare bought the nursing home’s assets for about $6.5 million plus $2.25 million to $3 million for its estimated debt.

 

The Des Moines Register continues their excellent reporting of the problems at Iowa’s nursing homes.  Five Iowa nursing homes have each been fined more than $8,000 because of allegations of resident neglect that resulted in two deaths, a leg amputation and other injuries.

The Good Samaritan Home in Indianola was fined a total of $24,500 for a series of problems involving different residents, including one who allegedly lost a leg to gangrene. The staff noticed the resident had a blister on his or her left foot on Christmas Day last year. Over the next four weeks, staff members documented the resident’s complaints of severe pain as the wound grew in size, turned black, then emitted a foul odor. On Jan. 23, the resident begged for help, telling the staff, “I want to go to the hospital. I can’t take the pain anymore.” The resident was admitted to the hospital with a diagnosis of gangrene and bone infection, which resulted in the left leg being amputated above the knee.  Good Samaritan was fined $10,000 for failing to adequately care for the resident.

The home was fined an additional $9,500 for failing to monitor a resident who sustained a bleeding head wound and a hip fracture after falling out of a mechanical lift.  After the resident fell, the staff went to dinner or were summoned to work in the dining room. When the resident’s daughter arrived, the resident was alone, on the floor with no blanket and was bleeding from the head wound.  The daughter remained by her side for the next 35 minutes until an ambulance  arrived. No workers checked on the resident or provided any services.

Good Samaritan was fined an additional $5,000 for failing to prevent a serious injury. A resident of the home had fallen out of a recliner four times over a period of several weeks. The last fall resulted in a broken clavicle.

Several other Iowa care facilities have recently been fined for problems related to resident care. Among the cases:

The Keystone Nursing Care Center was fined $15,000 when a resident died six days after a series of falls there.  The facility allowed the resident to fall in March, April and May. On July 12, the resident was found on the floor and taken to a local emergency room. Doctors diagnosed the resident with a skull fracture and brain bleed. The resident died on July 18, and the home was cited for failing to provide adequate supervision of residents.

Altoona Nursing and Rehabilitation Center was fined $8,000 after state inspectors reviewed 19 patient files and found that in 16 cases the home hadn’t taken adequate measures to prevent falls. In a four-month period, the home documented 133 falls.  In one case, a resident was found on the floor crying out in pain, then taken to the hospital and treated for a broken leg. The resident died 10 days later.

The home’s dementia unit reportedly had only one nurse aide to care for 17 residents during an eight-hour shift, although several of the residents were incontinent, needed feeding assistance or required the help of at least two workers to get to the bathroom. Some of the alarms used to alert the staff to wandering residents weren’t working properly, the state alleged.

“I have told them about the alarms being broken,” one worker reportedly told inspectors. “It gets scary back here when you’re trying to care for two to three residents at once and alarms are going off. You can’t even call for help because you are so busy.”

Ogden Manor was fined $8,000 after staffers allegedly tried to prevent a resident’s dentist from calling 911 to summon emergency medical personnel.  The resident arrived at a dentist’s office by bus and was helped inside by the driver. The dentist’s staff called Ogden Manor to report that the resident was crying, seemed to be in pain and was asking to be taken to the hospital. The Ogden Manor staff allegedly told the dentist’s staff not to call 911, adding that the resident had been like that for days and was fine. When the resident was finally admitted to a hospital, he was diagnosed with gastrointestinal bleeding, severe anemia, dehydration and a dental infection. 

The Akron Care Center was fined $10,500 for allegedly failing to provide residents with a safe environment, and $2,000 for allegedly failing to provide residents with the required nursing services. One resident was hospitalized with a head injury after a fall, and another was hospitalized with bowel problems the staff had allegedly failed to assess.

 

A new survey from the federal Agency for Healthcare Research and Quality was released called Nursing Home Survey on Patient Safety Culture based on what more than 16,000 people who work at 226 nursing homes have to say about where their facilities fall short.  AHRQ Survey Part 1 and 2.

The survey corroborated common knowledge: 

Nursing homes are understaffed and overworked.  Only 41 percent agreed that the facility had enough staff to handle residents’ needs safely, and almost two-thirds agreed that staff had to hurry because there was too much work to do.

Workers also rate nonprofit homes higher than for profit ones.  This confirms what researchers have reported for years.

Smaller facilities are better.  In nursing homes with 49 or fewer beds, 77 percent of staff members awarded their facility high safety ratings over all. In facilities with more than 100 beds, only 59 percent did.