The Obama administration announced $1 billion in funding to hire, train and deploy health-care workers, part of the White House’s broader “We Cant Wait agenda.  Grants go to organizations that work with patients in federal health-care programs such as Medicare and Medicaid. The funds are for experimenting with different ways to expand the health-care workforce while reducing the cost of delivering care. 

Health-care employment is growing steadily, with more than 300,000 jobs added in the past year,
according to the Bureau of Labor Statistics.  The bureau projects total employment in health
care to grow by 3.2 million jobs by 2018, more than in any other sector.

The need for a larger health-care workforce will become acute in 2014, when health insurance expands coverage to millions of uninsured Americans. By 2019, the nonpartisan Congressional Budget Office projects, 32 million more Americans will have gained health insurance coverage.

The Center for Medicare and Medicaid Innovation, created as part of the Affordable Care Act, will administer and oversee the program, called the Health Care Innovation Challenge.

 

MetLife issued the following press release about the rising costs of long term care despite the recession and reduction of medicaid and medicare reimbursements.

Costs continue to rise for those requiring long-term care in the U.S. According to the newly released 2011 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs, conducted by the MetLife Mature Market Institute, national average rates for a private nursing home room increased 4.4% to $239 daily or $87,235 annually, in 2011. Assisted living base rates rose by 5.6% to $3,477 monthly or $41,724 annually. Adult day services went up by 4.5% to $70 per day. Home health aides and homemaker/companion service rates were unchanged at $21 and $19 per hour, respectively.

The highest average daily rates for nursing homes continue to be in Alaska, where rates decreased slightly to $655 for a private room compared to $687 in 2010. Costs were lowest in Louisiana, outside the Baton Rouge and Shreveport Metropolitan Statistical Areas (MSA), at an average of $141 per day for a private room.

For assisted living, the Washington, D.C. area had the highest average monthly base rate at $5,757, a 10% increase from last year. Arkansas, outside of the Little Rock MSA, had the lowest average monthly rate of $2,156, also an increase.

“This year’s increases are greater than previous years. The state of the economy, combined with rising health care and energy costs, are having a significant impact on long-term care rates. In fact, long-term care rates continue to outpace the medical inflation rate,” said Sandra Timmermann, Ed.D., director of the MetLife Mature Market Institute. “The result is dramatic protracted inflation that will impact consumers. As the cost of care continues to rise, Americans need to discuss long-term care planning with their families now, to ensure they receive the kind of care they want in the future. This is especially critical at a time when retirement savings rates are low."

The MetLife Market Survey and accompanying report provide a good deal of additional information regarding various types of long-term care available in the U.S. and a detailed breakdown of costs by region.

Nursing Homes:

According to the U.S. Census Bureau, in 2010, 66% of nursing home residents were women. The median age of residents was 82.7 years.
Fifteen percent of nursing homes surveyed have an associated assisted living unit or wing; 11% are part of a continuing care retirement community (CCRC).
A small percentage (10%) of nursing homes surveyed provide adult day services.
The majority (87%) of nursing homes surveyed provide Alzheimer’s or dementia care; of those, 80% charge the same rate for care.

Assisted Living:

Current estimates from the American Seniors Housing Association indicate that the average age of an assisted living resident is 86.9 years old, and the median length of stay in assisted living is 25.6 months.
Oversight of assisted living communities rests primarily with state governments rather than federal regulation. In 2007, several states strengthened existing standards or implemented new standards for communities with residents with Alzheimer’s disease or other forms of dementia.
Almost three-quarters (72%) of assisted living communities surveyed provide Alzheimer’s and dementia care, 50% of which charge an additional fee for the service.
Home Health Care:

The majority (79%) of the home health care agencies surveyed provide Alzheimer’s training to their employees, and almost all (99%) agencies surveyed do not charge an additional fee for patients with Alzheimer’s.
While most home care agencies surveyed provide an hourly rate, 81% of the agencies require a minimum number of hours per day ranging from 30 minutes to eight hours with three hours being the average. Small percentages (3%) provide a daily rate. About 32% of those surveyed have a 24-hour or live-in rate. The average daily live-in rate for a home health aide is $258 and $255 for a homemaker/companion.

Adult Day Services Centers:

More than three-quarters of adult day services centers surveyed are open Monday through Friday; 6% are also open Saturdays and 13% are open seven days per week. For those open 24 hours, 67% provide full adult day services for all 24 hours. Seven in ten centers provide transportation services to and from the center. Of these, 47% do not charge a fee for these services. Of those that charge for transportation, the average one-way fee is about $8.
Almost all (98%) of the centers surveyed provide services for those with Alzheimer’s disease, with 2% of these charging an additional fee.
2011 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs can be downloaded from www.MatureMarketInstitute.com. The publication can also be ordered through Contact Us on the MetLife Mature Market Institute Web site, by writing to: MetLife Mature Market Institute, 57 Greens Farms Road, Westport, CT 06880 or by e-mailing MatureMarketInstitute@metlife.com.

Methodology

The MetLife survey of 2,003 nursing homes, 1,492 assisted living communities, 1,644 home care agencies and 1,341 adult day services, in all 50 states and the District of Columbia, was conducted by telephone between April and August 2011, by LifePlans, Inc., for the MetLife Mature Market Institute.

The states were divided into three groups, according to the population—under three million, three to 10 million and over 10 million. These groupings were determined using data from the 2000 U.S. Census and updates. The cities/areas surveyed were chosen on the basis of population and the ability to obtain a representative sampling of facilities and providers. For the “rest of state” areas, a sample of service providers or facilities were randomly selected from all providers or facilities identified in the state not already identified in the Metropolitan Statistical Area (MSA) sample. Costs for this survey were calculated for each service provider in an area and were aggregated across all providers to compute a statewide average cost. All costs are rounded to the nearest whole dollar amount.

The most vulnerable Americans and their families will no longer be forced to give up their legal rights and sign one-sided mandatory binding arbitration clauses under legislation recently introduced in the U.S. Senate.

The bipartisan Fairness in Nursing Home Arbitration Act of 2009, introduced by Sen. Mel Martinez (R-FL) and Sen. Herb Kohl (D-WI), will prevent nursing homes from deliberately hiding clauses within the fine print of contracts that force seniors to surrender their right to trial by jury and enter an unfair and one-sided mandatory binding arbitration process. The bill was introduced in the U.S. House last week by Rep. Linda Sanchez (D-CA).

“The Fairness in Nursing Home Arbitration Act will make sure negligent nursing home corporations can be held accountable by our most vulnerable citizens,” said American Association for Justice President Les Weisbrod. “This bill will prevent nursing home corporations from unfairly preying on seniors and stripping away their legal rights. Arbitration should only be voluntarily, not hidden away in the fine print of contracts during our seniors’ greatest time of need.”

The Fairness in Nursing Home Arbitration Act of 2009 will help people like Minnesota resident Dean Cole, who received unconscionable care from a negligent nursing corporation. Suffering from dementia, Dean needed help eating meals every day; but during his 22 day residency, Dean lost 20.6 pounds without his physician or wife ever being notified. After being admitted to the hospital, he was found to be severely dehydrated, with a water deficit near 10 liters. Dean died less than a month later. His family sought justice by bringing a suit against the nursing home for negligent care, but learned they would be forced into one-sided mandatory binding arbitration on the corporation’s own terms and denied the right to trial by jury. The case is still pending.

 

A Michigan jury in Macomb County compensated the family of a resident $2.35 million after he
died from choking on a meatball in a Sava nursing home. After an eight day trial and careful
deliberations, the jury concluded that Sava Senior Care Inc., which owned and operated Nightingale Nursing Center, was negligent and caused the death of Walter Polomski, 56, who choked on a golf ball-sized meatball and died after going 15 to 30 minutes gasping for oxygen.  Sava is owned by Murray Forman who also owns and operates the Fundamental Long Term Care Holdings chain of nursing homes.

Sava claimed their subsidiary, SSC Warren Woods Operating, the name on the license, should be
the only Sava entity responsible.  The family’s attorney, John Perrin, said “People need to know that the name on the building isn’t always the company that’s operating the facility,” Perrin said. “There are a lot of shell companies.  Because the real owners don’t put their name on the building, they don’t provide good care.”

Walter Polomski died March 23, 2008, four hours after a meatball got stuck in his trachea
instead of going down his esophagus about 11:35 a.m. at lunch. Polomski never should have had
been given the meatball because he had swallowing problems with doctor’s order for altered
foods. The sole nursing home staffer in the dining room didn’t know the Heimlich maneuver and
instead wheeled him 40 feet or more to a nurse’s station. Another nurse unsuccessfully
performed the Heimlich maneuver on Polomski in the wheelchair then placed him on the ground.
Then another poorly trained nurse tried to force air into his lungs with an “ambu bag,” which
exacerbated the problem. The nursing home failed to call 911 for at least 12 minutes, or properly
staff the dining room, where there should have been at least five staffers. EMS arrived quickly,
and a paramedic removed the meatball with forceps. Polomski died at the hospital on Easter Sunday.

The jury awarded $1.5 million for Polomski’s pain and suffering, $750,000 for the family’s past
“loss of society and companionship” and $100,000 for future loss of companionship. Two jurors
said they agreed Sava was negligent but disagreed with the amount awarded.

The victim’s brother, Richard Polomski was emotional following the verdict.  “I’m ecstatic because my brother’s story was told and I got to find out what exactly happened to him,” Polomski said. “The nursing home was not telling me what EMS was telling me. That’s what prompted me to file a lawsuit.”

Defendants tried to ignore their responsibility by claiming that Polomski’s life expectancy was
only about four to 10 years.

As we previously discussed, a jury decided in August that the family of Dorothy Douglas, who
died from neglect at ManorCare’s Heartland of Charleston facility in 2009, should receive $11.5
million in compensatory damages and $80 million in punitive damages. She was deprived of
proper hydration that led to her death. Staff failed to make sure she had enough water and
that she was eating properly. On several occasions, Douglas told his mother’s nurse aides that the woman was not getting enough to drink, and asked them to make sure she had water next to her bed at all times.  The nursing home did not have enough staff members, an assertion backed by former employees who said due to the poor working conditions they could not properly care for residents.

However, a circuit judge has now entered a judgment order reducing a portion of a $91.5 million
jury award. The order reduces a $5 million segment of that award to a maximum of $4,594,615.

At issue is whether a 2003 state law arbitrarily limiting medical malpractice awards to $500,000
should apply to a simple negligence action against a nursing home. The caps, which state
lawmakers instituted under West Virginia’s Medical Professional Liability Act, prevent victims alleging medical malpractice from recovering more than $500,000 in non-economic damages. Heartland and parent company ManorCare, believes the case is subject to those caps because nursing homes are medical providers. But making sure a resident has enough water is not a medical decision. Such verdicts call attention to improper care in some nursing homes and are warranted based on the profits large companies report.

The defense lawyers also complain that multiple legal errors were made during the trial —
including a misstatement of the earnings of the home’s umbrella corporation. The jury was told
that HCR Manor Care made $4 billion in profits in 2009 based on a tax return statement from
that year but that was gross revenue.  Defendants also argue that the verdict form the jury used during the trial did not specify damages for each defendant named in the suit, and instead lumped them together, denying their rights of having a separate determination of liability. The verdict form also directed the jurors to give a $5 million award to Douglas’ sister Carolyn Douglas Hoy, who wasn’t named as a party in the lawsuit.

Allen Young writes articles for mastersingerontology.com/, a website dedicated to providing students with the information and tools needed in order to pursue their Masters in Gerontology.

 

He thought that our readers might be interested in the latest article he posted called 40 Informative Forums on Long-Term Elderly Care

"One of the most important aspects in studying for a master’s in gerontology is long-term elderly care. Seniors often need to be placed into nursing homes, assisted living facilities, or some other form of long-term care during their lives. But with news, laws, and regulations coming in on a regular basis, it can be difficult to keep up with it all.

To help, we have gathered 40 informative forums on long-term elderly care. They contain the latest discussions on the topic, as well as the many others that relate to it such as law and money. There are even a few to help you choose the best long-term care and get the latest expert advice."

 

Kathleen Sharp wrote in the Opinion Page of the NY Times about solving the budget problems related to Medicare and Medcaid by reducing health care fraud.  Below are excerpts of that editorial:

But before charging consumers more and eliminating valuable services, we should be much more aggressive in recovering money stolen from these taxpayer-supported programs. According to some estimates, health care fraud is a $250 billion-a-year industry, and about $100 billion of that is stolen from Medicare, the health care program for the elderly, and Medicaid, the insurance program for the poor and disabled.

There are many ways to defraud taxpayers. For example, a hospital chain can buy drugs at a steep discount and then bill Medicare for high sticker prices. Doctors can bill for procedures that never happened, or for drugs that were supplied to them by pharmaceutical companies free of charge, or pharmaceutical companies can promote a drug for risky, unapproved uses.

Recovering billions of dollars from these ruses won’t solve the problem of rising health care costs, but it’ll go a long way in helping to reduce waste and protect services.

Many states already aggressively pursue health care fraud. In 2005, a whistle-blower accused Quest Diagnostics, the chain of medical laboratories worth over $7 billion, of deliberately overcharging California’s insurance program for poor and disabled people, Medi-Cal, for more than 15 years. He alleged that Quest had paid kickbacks in the form of free tests and discounts to doctors and hospitals that referred patients to its labs. Recently, while denying wrongdoing, the company settled for $241 million. According to California’s attorney general, Kamala D. Harris, it was the largest fraud settlement in the history of the state’s False Claims Act.

Quest isn’t accused of defrauding only California, however. Andrew Baker, a health care executive who ran a company acquired by Quest, has accused it of overbilling our national Medicare plan by as much as a billion dollars. The case was dismissed for technical reasons that had nothing to do with its merits, and Mr. Baker is appealing the dismissal. Oddly, the Department of Justice has not joined him.

Why not?

It could be that the Justice Department prefers to let the state attorneys general do the heavy lifting. Once a state wins a case, the feds can piggyback onto it. This may be happening in the Quest case since the department said it reserved the right to join the case later. But why wait? According to a public statement made by Mr. Baker (who, thanks to the False Claims Act, which encourages individuals to expose wrongdoing by giving them a cut of the recovery, could earn about $1 million from the case), the inaction could be explained in another way. “Quest is too big to go after,” he said. The department instead seems to focus on individual physicians, like the Miami-area doctor recently convicted of billing Medicare $23 million for phony injections.

Compare this to Pennsylvania, which just obtained $49 million from four companies accused of selling drugs to state agencies at inflated prices. South Carolina, Idaho and other states are settling similar suits, and still the Justice Department idles.

At the beginning of this year, the Justice Department had more than 1,300 whistle-blower cases under investigation, the bulk of them related to pharmaceuticals, hospital chains and health care companies. That’s up from the 900 or so cases that were stalled during the end of the Bush administration. To be fair, the department has long been understaffed when it comes to health care investigations. But in 2009, the Justice Department and the Department of Health and Human Services were given an additional $198 million to combat health care fraud. Neither the money nor a new task force seem to have helped much.

Last year, the Justice Department recovered $3 billion in false claims, $2.5 billion of that from health care cases. But that’s just a drop in the bucket. It’s gotten so that even if a case is settled, many pharmaceutical companies simply write it off as the cost of doing business. After all, if you’re selling tens of billions of dollars’ worth of drugs in one year, a $2 billion settlement is a slap on the wrist.

The only way to tell if taxpayers are getting their money’s worth of fraud-fighting is for the Department of Justice to routinely publish, among other statistics on corporate fraud, a breakdown of the number of cases it opens and the number originating from whistle-blowers.

This should be a priority. Health care costs are rising toward unsustainable levels. But before we start cutting important programs, let’s go after the fraudsters.

 

The Houston Chronicle had a recent editorial about the two-part investigative series authored by Terri Langford about "unscrupulous operators who make millions of Medicare dollars exploiting the most vulnerable of our local residents through private ambulances and for-profit psychiatric clinics – with both scams feeding off each other."  Below is part of the editorial:

Medicare, and American taxpayers, are footing the bill, which is enormous: Hundreds of private Emergency Medical Services vehicles carry patients every day – at considerable cost, and whether they need ambulance transportation or not – to so-called therapy programs in the Houston area. Langford, who spent more than a year researching her story, documented numerous instances of physically sound individuals repeatedly carried by ambulance to and from therapy.

What is almost as alarming as the rampant fraud is the fact that Medicare itself has made it easier for these scam artists to make a killing: Federal law enforcement agencies have, over the years, uncovered ample evidence of "kickbacks, fraud and the hunt for patients with Medicare benefits," reported Langford. Harris County officials have complained to Medicare for two years of widespread fraud by private EMS companies, but said they received no response. And Medicare’s Texas billing contractor recently warned companies that, since 2007, it has targeted non-emergency transports in Texas as its number one problem.

One of the major hurdles to prosecution lies with the "physician certification statement," like a prescription, explaining why a patient needs EMS transport, which the provider is required by Medicare to obtain before transporting a patient. Medicare stipulates that tax dollars can only be used when a ride is "medically necessary and reasonable," and not when "some other means of transportation … could be used without endangering the individual’s health."

But that is a vague stipulation, one that ties prosecutors’ hands. Another invitation to abuse is that the provider is never required to submit that statement to Medicare when processing a claim. Medicare should promptly clarify "necessary and reasonable," and demand evidence of need. It should also beef up its investigative process and stop ceding control of its transactions to contractors. It’s a more than $700 billion agency. It can afford to invest a little to recoup some of the millions it’s currently losing in Houston.

While Medicare is in no way responsible for their illegalities, it has known for years that corrupt companies were making hay in Houston and did little to rein them in. It’s past time to get serious and put them out of business.

 

Federal authorities in New York City charged 12 people — including several doctors — with scheming to submit more than $95 million in false Medicare claims. The 12 were charged with participating in Medicare fraud and money-laundering offenses.  In addition to three medical doctors, they include a chiropractor and a doctor of osteopathy.

As part of the scheme, prosecutors said three Brooklyn health clinics paid kickbacks to Medicare beneficiaries and used the beneficiaries’ names to bill Medicare for $71 million worth of services that were never provided.  Money laundering "is a critical part of large scale health care fraud schemes and often the most difficult piece to unravel."  U.S attorney stated.

A second, related indictment charges that six defendants recruited Medicare beneficiaries to their Queens clinic by offering lunches and dancing classes in exchange for their Medicare numbers, which would be billed for medical services that they did not need and never received.

See articles at Wall Street Journal,

I wanted to use this Thanksgiving day to thank the members of the community who have answered the call to participate on a jury.  Jurors are crucial to the judicial system.  Fair, impartial, objective fact finders are critical to finding the truth, and keeping corporate chains accountable for their shortcuts and neglect.