A recent report from consulting firm van der Walde & Co., released by the Partnership for Quality Nursing Home Care found that one-third of nursing home operators had a zero total margin or net loss even before sequestration occurred.  Many of these operators siphon funds away from operational costs by creating administrative and back office costs.  The industry blames low profitability, tighter access to capital, and cuts to Medicare and Medicaid payment rates.

"Mounting financial pressures could even force SNFs to reduce expenses by means of cutting labor, limiting technology investments, as well as cutbacks to facility renovations and new equipment."

So they pretend not to make money so they can cut the staffing and beg for more government money.


Health Affairs reported on the new report that used the RAND COMPARE microsimulation to analyze how opting out of Medicaid expansion would affect coverage and spending, and whether alternative policy options—such as partial expansion of Medicaid—could cover as many people at lower costs to states.

With fourteen states opting out, the study estimates that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016, compared to what would be expected if all states participated in the expansion.

The report concludes that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.

The Daily Mall reported that a circuit judge has granted a request for a $50 million bond to be obtained on behalf of the plaintiffs in a nursing home lawsuit that resulted in a $91 million jury verdict.  The verdict has been appealed to the state Supreme Court. The jury found that Douglas died as a result of neglect at Heartland of Charleston, owned by Manor Care Inc.  Douglas was a patient at Heartland for 19 days in 2009 before being transferred to a hospice facility and dying there. Attorneys argued that dehydration and other lack of care at Heartland caused her death. The jury determined the nursing home was at fault and awarded the family $11 million for her death. They awarded $80 million in punitive damages against the company.  Last month the judge denied a request for a new trial in the case and it was sent to the Supreme Court.

Attorney Michael Fuller told Kanawha Circuit Judge Paul Zakaib that a bond was necessary as the higher court considered that monetary award.  The nursing home is covered by two primary insurance companies – Manor Care Insurance Ltd. and AIG – for any amount over $10 million. But several other insurers are involved as well.


Nursing home lobbying groups have to make hard sacrifices in the face of the recession. Healthwatch reports that the American Health Care Association (AHCA) and The Alliance for Quality Nursing Home Care (AQNHC) will merge under the banner of the AHCA.  The two groups have been forced by economic realities to form one advocacy group. They hope that the merger will bring about one unified voice to lobby for the nursing home industry.  

They complain that if Medicaid continues to cut prices, residents will suffer, and with the Baby Boom generation getting older, nursing homes will be facing more residents, adding increased pressure to the new AHCA. Advocating as the new AHCA, the two groups will be facing increasing pressures in the future.

See articles here and here.

USA Today reported that new payment plans, improved efficiency and a move toward consumer-driven insurance plans adopted and accelerated by the 2010 health care law will continue to force down overall Medicare costs, according to industry analysts and studies, even as the economy continues to improve. These innovations caused the $618 billion drop in projected Medicare and Medicaid spending over the next decade that was reported May 15 by the Congressional Budget Office.  That report showed that costs for the two programs in 2012 were 5% less than projected in early 2010, and the CBO data are expected to foreshadow the spending projections in the annual Medicare trustees report scheduled to be released this week.

Health spending grew about 3% a year from 2009 to 2011, a drop from the average 6% annual growth the previous decade.  An analysis of health costs for employees of large corporations showed per-employee health spending also decreased. Those savings came from more cost sharing for employees and higher co-payments and higher insurance deductibles. Those factors accounted for 20% of the reduced spending.  A continuation of that trend through 2012, he said, could cut public-sector health spending by $770 billion less than predicted.

Administration officials say some of the lower spending can be traced to the law. Penalties for hospitals that readmit patients for the same condition within 30 days of their release have driven the readmission rate from about 19% to below 18%, said Patrick Conway, chief medical officer for the federal Centers for Medicare and Medicaid Services.


Accountable care organizations, which receive their Medicare payments based on quality not the number of procedures performed, have also reduced costs, Conway said, as have electronic medical records.


The Orchard House Nursing Home in Belfast recently reported an alleged assault to the police. The sexual assault has been neither confirmed or denied, but police are conducting an investigation, and the Regulation and Quality Improvement Authority (RQIA) has been notified. Authorities said there have been a string of break ins in the area and the home has an open door policy. They say that if an incident did occur, it’s likely that an intruder got into the home. The home has a good reputation in the area. Authorities are still investigating, and have not definitively concluded whether an incident even occurred. Regardless, the home has stepped up security and is reviewing their open door policy.
See article at BBC.

The Australian Medical Association (AMA) says that hospitals are running out of room. Since nursing home residents are checking in earlier and living longer, the homes are running out of available beds. What this means for hospitals is that patients who should be in a nursing home are having to stay in hospitals longer because there is no room for new residents at nursing homes.

The government recently built a 100-bed facility next to Royal Darwin Hospital to allow remote area patients to use while getting treated at the hospital. Their volume cannot keep up with the demand. Because of this, hospital officials want to use the facility to be a medi-hotel, or an extension of the hospital. If the facility was used as a medi-hotel, it could ease many of the pressures facing the hospital. The hospital and the government are at a stalemate right now, trying to reach a decision about the facility.
See article at ABC.

In a report on the unbelievable abuse against nursing home residents, Fox 4 in Dallas details the shocking and alarming treatment that four residents suffered at the hands of caregivers.  The original report, in video format, shows videos and photographs of the abused. The photos are shocking, detailing injuries that arose from workers’ abuse and carelessness, but the videos are much worse.

Three videos detail the horrendous treatment that these gentle vulnerable residents suffered. Among the abuses were pinching, slapping, name calling, hair pulling, and general roughness. Minnie Graham suffered numerous abuses at the hands of her caregivers, two of whom consistently used unnecessary force when handling her, and one slapped her in the face multiple times in the course of a few minutes. Her helpless cry of ‘Somebody help me’ is heart wrenching. When she gathered the courage to say something back to her tormenters, the aide shoved his middle finger in her face. Mrs. Graham died about a month later. Her granddaughters, who had placed the hidden camera in her room and captured the abuse, said that they believe she died because of a broken spirit.

The authoritative body in Texas never charged Winters Park Nursing and Rehabilitation Center with anything. Had the home been charged, they would have faced a paltry fine. Texas, like South Carolina, is among the lowest states in the nation for nursing home fines. If the facility agreed to pay the fine, another 35% would have been taken off. In Texas, the home is responsible for the abuse, and when paying the price, they get a discount.

The two aides who abused Mrs. Graham still held their licenses, one even worked at another nursing home. Fox 4 asked the police why one aide had never been arrested. The police response: We couldn’t find her. But Fox 4 found her – at the same address that was listed in her records. The lack of concern for prosecuting this woman, investigating the home, and enforcing the rights of nursing home residents reveals a terrifying lack of consideration for the elderly on all levels, the nursing home, the police, and even the department responsible for nursing home regulations and investigations.

Many times, reading the statistics, or looking at figures of beds and financial costs, it is easy to forget the reason that nursing homes exist: to care for those who cannot care for themselves. However, when the care that one is receiving more closely resembles abuse than assistance, it is clear that nursing homes need to constantly be reminded that their residents are people. They hear, they talk, they feel. They should be treated like the human beings that they are. Instead, they are treated as less than human, simply because they cannot fight back. Don’t let this become your mother, or your father, or you.

The SF Gate reported that a Minnesota nursing home worker had been fired for stealing drugs from a resident. North Ridge Care Center in New Hope reported the worker to health officials and the police. The worker stole Oxycodone from the resident who had been prescribed the narcotic for pain management. The worker admitted to taking medication from 12-24 patients over four months. As a result of the worker’s theft, the home implemented a new system to prevent medication theft. See full article at TwinCities.

NPR reports on the VA’s new telemedicine project. The VA is using technology so doctors can treat rural patients remotely. Veterans in locations that are difficult to access can now, courtesy of this new technology, be seen by doctors without having to leave their home. With the veterans from the Korean and Vietnam wars reaching an age where medical care becomes a potentially lifesaving necessity, this type of telemedicine is being used all around the country in small cases.

In Alaska, the terrain and locale make it the obvious place to begin a full scale telemedicine project. While patients can still go to the VA doctor’s office, if they live in a low access area, they can choose to see their doctor via video channel. Some people think this is a great idea, others predict problems quickly arising.

The positives are lower travel costs and less time and money spent, but the drawbacks are nothing to scoff at. The equipment is costly and doctors don’t have the benefit of seeing the patient in person. While telemedicine does have good video quality, it is still very different than examining a patient in the flesh. With the implementation of telemedicine, the costs and the benefits will have to be weighed. Whether or not it’s feasible for the rest of the country, Alaska and its veterans are using and enjoying the equipment.