U.S. News & World Report and Forbes each had articles recently on a new study titled "Effects of Nursing Home Stays on Household Portfolios" published in the June 2012 EBRI Issue Brief #372.  After six months, nursing home residents will, on average, lose half their assets.
Executive Summary

•Nursing home stays among retirees have increased steadily during the past decade. Among people age 65 and higher, nursing home stays increased from 6 percent in 2000 to 8.5 percent in 2010.
•Nursing home stays have strong and statistically significant negative effects on every type of household asset holdings except higher-risk assets (such as stocks, bonds, and mutual funds).
•Among nursing home entrants, purchase of long-term care insurance (LTCI) has also increased steadily during the past decade, but coverage remains low (14 percent in 2010).
•For those who spent six months or more in a nursing home facility, nearly half were covered by Medicaid.
•Those who reported being most likely to enter a nursing home in the near future were also less likely to purchase LTCI.
•Over the past decade, use of professional home-health care has increased steadily, as has the percentage of people with LTCI who use professional home-health care. But here also (for those using home-health care), LTCI coverage is low—13.2 percent in 2010.
•For those who have lived in a nursing home for six months or more, the median total household wealth was only $5,518.
•After respondents’ first entries into a nursing home, total household wealth fell steadily over a six-year period. By comparison, household wealth increased steadily over any six-year period for those who never entered a nursing home.
•For nursing home entrants, median housing wealth falls to zero within six years after the initial nursing home entry.
•Both mean and median levels of every type of wealth are much higher for those who did not use professional home health-care than those who did.

 

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KSAT.com out of Texas had an interesting article and a good followup from this morning’s blog about Texas tort reform.  KSAT reported that since tort reform passed in Texas a few years ago, lawsuits against nursing homes are few and far between.  Nursing homes in Texas (and many other states including South Carolina) do not have to carry insurance and there is an arbitrary cap on damages that discourages lawyers from taking cases, even worthwhile ones.  Additionally, despite the arbitrary caps, the victim must pay back Medicare and Medicaid for any medical bills paid caused by the nursing home’s negligence.  In the end, tort reform protects negligent health care providers, unjustly limits a victim’s compensation, and takes away the constitutional right to a jury trial.

"Consumers of nursing home services are being badly, badly deprived of a remedy," attorney Marynell Maloney said.  She said "If there were bad lawsuits before, now there’s really bad care with no remedy for a lot of injured people," Maloney said. 

 

American Statesman reported on a new study that proves tort reform does not lower premiums for doctors or reduce health care costs.   The study found no evidence that health care costs in Texas dipped after a 2003 constitutional amendment limited payouts in medical malpractice lawsuits.  Proponents guaranteed that health care costs and insurance costs for doctors would go down dramatically.  However, the only thing that decreased was the quality of care at nursing homes.

The researchers, who include University of Texas law professor Charles Silver, examined Medicare spending in Texas counties and saw no reduction in doctors’ fees for seniors and disabled patients between 2002 and 2009.  Consumer group Public Citizen found Medicare spending in Texas rose much faster than the national average after tort reform.

Researchers found no difference in Medicare spending after tort reform and indications that doctors in higher-
risk counties did slightly more procedures.

Since tort reform, some Texas residents have complained that they cannot find a lawyer to pursue a malpractice case because of the arbitrary cap on compensation for pain, suffering, disfigurement and mental anguish.  The limit makes litigation costs prohibitive.

 

There have been lots of polls taken about how Americans feel about the Affordable Care Act.  The amazing thing is that a majority of Americans do not approve of the law despite a majority liking most of the provisions of the law.  The easy explanation is that many Americans are misinformed about the law and/or wanted the law to go further (i.e. Medicare for all or public option or universal health care coverage).  A good portion of the opposition to the healthcare law is because Americans want more reform, not less of it.  Polls found that a large number of Americans – including about one-third of Republicans and independents who disagree with the law – oppose it because it does not go far enough to fix healthcare.

Recently Reuters/Ipsos reported on a recent poll that they took on this issue and the results are fascinating.  Strong majorities favor most of what is in the law but 56 percent of people are against the healthcare overhaul in general and 44 percent favor it.

Support for the provisions of the healthcare law was strong:

82 percent favor banning insurance companies from denying coverage to people with pre-existing conditions;

61 percent are in favor of allowing children to stay on their parents’ insurance until age 26;

72 percent back requiring companies with more than 50 employees to provide insurance for their employees.

The Guardian also had an article on the polls and Americans lack of understanding of the health care reform bill.  "Most Americans may not like Obamacare as a whole, but they seem to like it as long as it doesn’t include the mandate. Only 34% of respondents in the CBS poll approved of Obamacare as a whole, but 51% either wanted the bill kept intact or only wanted the mandate eliminated. A Fox News poll similarly discovered that only 40% of Americans favored the healthcare bill as a whole, but 51%, again, wanted to keep either the whole law or most of the law minus the mandate."

"Yet, only 34% of the general population opposes Obamacare because it goes too far; 13% of Americans asked actually oppose it because it is too timid. When you combine those who oppose it for not going far enough with those who favor it, a majority, 56%, actually wants Obama’s healthcare bill or something more far-reaching."

"Only 51% of adults in an April 2012 Kaiser poll responded that they had enough information to understand how the law would impact them personally. A March CBS poll gave pretty much the same result. How can Americans judge a healthcare law that will make a difference in lives, if they don’t comprehend how it will?"

 

 

PsychCentral and Medicalxpress both published recent articles that explained the importance of staff unity in nursing homes. The information in these articles came from a study published in Health Services Research.  The study found that feelings of staff unity in long term facilities have a direct effect on the quality of care the residents receive.  As reported in the study, when employees feel cared for and like a vital part of a team they provide their residents with a better quality of care. Proper communication, employee benefits and incentives, and adequate staffing are instrutmental in developing staff untiy.

The lead author of the study explained further saying, “We know from other fields of medicine that teamwork – the relationship between coworkers that facilitates decision making and care coordination – plays an important role in the quality of care.”

The articles explained that the study used 45,000 residents in over 160 nursing homes in the state of New York.  The study focused on the frequency of pressure ulcers in the residents, which the authors of the study view as a good indicator of staff communication, or lack thereof because decreased unity causes poor care coordination, lessened communication, and unsatisfactory transfers during shift changes which increase the risk of pressure ulcers.

On the other hand, increased staff unity; the sharing of common goals, values, and responsibility decrease the prevalence of pressure ulcers by encouraging regular monitoring, routing repositioning of the resident, and communication between staff.  The study found that a mere 0.25 increase in staff unity results in a massive 4.5 decrease in the prevalence of pressure ulcers and a 7.6 percent decrease in incontinence, as reported in both of the articles of the articles.

“This study empirically demonstrates that better work relationships between staff, as measured by staff cohesion, are associated with better outcomes for nursing home residents,” said Temkin-Greener

A disappointing, yet unsurprising, article was published on NewJersey.com on yet another nursing home employee stealing from a vulnerable adult.  The article reported that Kye M. Giacalone has been charged with stealing over $29,000 from a helpless resident of Maple Glenn Nursing Home. 

Giacalone, while working in the admissions office of the facility, befriended one of the residents in an attempt to gain his trust.  After getting power of Attorney, Giacalone opened credit card accounts in the victim’s name, which she paid off with funds from his personal account.   Even after the resident moved facilities, Giacalone continued to steal from him. Authorities have advised that the investigation is still ongoing and the total amount of money stolen has not yet been determined.

A Maywood police detective commented, “She took advantage of the trust given to her.”

This is yet example the need for more stringent background checks and a higher quality of nursing home workers. Sadly, far too many nursing home employees are not the type of person a family would want to entrust their loved one to.

A recent article from The Birmingham News reported that authorities are searching for a former nursing home employee that fled after being accused of scamming at least six families of facility residents. Rhonda Jefferson of Arlington Rehabilitation Center, lied to the families, telling them that they could only pay for their loved one’s care with cash as the facility’s check processor was out of service. Jefferson was then pocketing the money, totaling up to $30,000.

Jefferson allegedly began stealing the money in October 2011 and was not arrested until February 2012 when she was charged with second degree-degree theft of property.  She was arrested again in March on first-degree theft.  Her most recent arrest came as a result of a more recent investigation and an internal audit that discovered more missing funds.  Jefferson is still at large.

It is scary to think that incidents like these can, and frequently do, occur in nursing homes. Families that have loved ones in nursing homes need to be warned to pay particular attention to the quality of staff they are leaving their loved on with and where the money is going.

Please click here to read Arthur R. Miller’s fantastic commencement speech to the University of South Carolina School of Law on October 13, 2011. 

He provides the most cogent analysis I have seen about why we are seeing such a narrowing of Seventh Amendment rights including the granting of summary judgment, the exclusion of expert testimony, the difficulty in certifying class actions, and the increased use of mandatory arbitration.  In addition, he confirms that without adequate preparation for and appreciation of the procedural and legal roadlocks erected over the last 20 years, plaintiffs simply cannot ultimately prevail.  It is thought provoking and illuminating, and should be required reading for all interested in the civil justice system.  Below are some excerpts:

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Philly Burbs and NBC Philadelphia had articles on the arrest of Virginia Marquardt after she allegedly stole over $300,000 from a 67-year-old woman in a nursing home.  Investigators say the victim had been in nursing home care since July of 2007.  Investigators say that soon after Marquardt, a registered nurse, obtained power of attorney for her former neighbor on July 31, 2007, she began spending the victim’s money on expenses that were not related to her care including expensive watches and vacations.

Virginia Marquardt obtained Power of Attorney for her, which gave Marquardt the ability to hold the victim’s money, control her assets and disburse them as needed. Marquardt took control of the victim’s bank account in August 2007 and also made herself a 50% beneficiary in the resident’s will.

Over the next several years, police say Marquardt only paid portions to the nursing home for the victim’s care and the outstanding balance continued to rise. The unexplained and suspicious use of the victim’s assets finally prompted an investigation in 2011 which found at least $300,000 in illegal payments from the account between August of 2007 and March of 2012 for the benefit of Marquardt and her husband Edward Marquardt.

 

 

The Philadelphia Inquirer reported the $50 million settlement  between OmniCare and the federal government.  Omnicare, Inc. manages pharmacies in nursing homes and other facilities in all 50 states.  Omnicare agreed to pay $50 million to U.S. taxpayers through the Drug Enforcement Administration to settle allegations stemming from a Justice Department investigation that began in 2007.

Among the allegations, according to the DEA:

•Routinely dispensing controlled substances to residents of long-term facilities without a prescription signed by a practitioner.
•In a limited emergency situation, dispensing controlled substances without an oral prescription called in by a practitioner.
•Dispensing controlled substances to residents of long-term facilities from prescriptions missing essential elements, such as drug name, dosage, strength, quantity, DEA registration number and practitioner’s name.
•Not properly documenting partially filled prescriptions thus preventing DEA from conducting an audit.

In 2011, Omnicare sold Omnicare Clinical Research to a private equity fund, which renamed the global, full-service contract research organization Theorem Clinical Research.

“Federal law provides that doctors, not pharmacies, are the ones who must prescribe these highly controlled substances,” Steven Dettelbach, U.S. Attorney for the Northern District of Ohio, said in a statement released by the DEA. “These laws and regulations are designed to balance the need to provide for patients while preventing misuse. This case demonstrates the need to follow those rules closely throughout the industry.”  Read the DEA statement here.